Healthcare Provider Details

I. General information

NPI: 1306109020
Provider Name (Legal Business Name): MONICA H BAHR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W BRIGGSMORE AVE SUITE I
MODESTO CA
95350-3839
US

IV. Provider business mailing address

2000 W BRIGGSMORE AVE SUITE I
MODESTO CA
95350-3839
US

V. Phone/Fax

Practice location:
  • Phone: 209-526-1440
  • Fax: 209-550-4903
Mailing address:
  • Phone: 209-526-1440
  • Fax: 209-550-4903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT90490
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: