Healthcare Provider Details

I. General information

NPI: 1700100203
Provider Name (Legal Business Name): BARBARA J. DRAHEIM PHD. MFT MFC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2010
Last Update Date: 03/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 NORTH LAKE BLVD.
TAHOE CITY CA
96145
US

IV. Provider business mailing address

P.O. BOX 6274
TAHOE CITY CA
96145
US

V. Phone/Fax

Practice location:
  • Phone: 775-831-7204
  • Fax: 775-831-1777
Mailing address:
  • Phone: 775-831-7204
  • Fax: 775-831-1777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberMFT-0316
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberMFC-26046
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: