Healthcare Provider Details

I. General information

NPI: 1417567066
Provider Name (Legal Business Name): CHARLISA F TRAPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17635 INDUSTRIAL FARM RD
BAKERSFIELD CA
93308-9520
US

IV. Provider business mailing address

813 S. OLEANDER AVE
BAKERSFIELD CA
93304-3551
US

V. Phone/Fax

Practice location:
  • Phone: 661-868-6840
  • Fax:
Mailing address:
  • Phone: 323-835-7573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT117989
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: