Healthcare Provider Details

I. General information

NPI: 1548781008
Provider Name (Legal Business Name): JUSTIN BAYNE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 EUCLID AVE
SAN FRANCISCO CA
94118-2510
US

IV. Provider business mailing address

PO BOX 373
NOVATO CA
94948-0373
US

V. Phone/Fax

Practice location:
  • Phone: 925-330-8945
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF97977
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT134928
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMF97977
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: