Healthcare Provider Details

I. General information

NPI: 1407396674
Provider Name (Legal Business Name): MARCUS OHLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2017
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 MARKET ST
REDDING CA
96001-1023
US

IV. Provider business mailing address

1407 SETTER DR
REDDING CA
96003-4562
US

V. Phone/Fax

Practice location:
  • Phone: 530-355-5656
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number119602
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number96036
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: