Healthcare Provider Details

I. General information

NPI: 1528893864
Provider Name (Legal Business Name): JUSTIN BAIN LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4132 KATELLA AVE STE 104
LOS ALAMITOS CA
90720-3493
US

IV. Provider business mailing address

10682 RITTER ST
CYPRESS CA
90630-4946
US

V. Phone/Fax

Practice location:
  • Phone: 562-343-6937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163180
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: