Healthcare Provider Details

I. General information

NPI: 1649624701
Provider Name (Legal Business Name): DAVID LAURENCE BA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 04/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 UNION AVE
BAKERSFIELD CA
93307-1051
US

IV. Provider business mailing address

1120 UNION AVE
BAKERSFIELD CA
93307-1051
US

V. Phone/Fax

Practice location:
  • Phone: 661-861-6141
  • Fax: 661-861-6165
Mailing address:
  • Phone: 661-861-6141
  • Fax: 661-861-6165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: