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General NPI Number Information
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NPI Number | 1578864203
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Entity Type | Individual
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Provider Name | PATRICIA LATHAM BACH PSYD, RN
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Gender | Female
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Dates
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Enumeration Date | 11/11/2010
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Last Update Date | 11/11/2010
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Provider Practice Location Address
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Address Line | 300 HARDING BLVD SUITE 203/204 K
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City | ROSEVILLE
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State | CA
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Zip | 95678-2470
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Country | US
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Telephone | 916-662-0767
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Fax | 916-652-0101
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Provider Business Mailing Address
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Address Line | 300 HARDING BLVD SUITE 203/204 K
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City | ROSEVILLE
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State | CA
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Zip | 95678-2470
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Country | US
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Telephone | 916-662-0767
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Fax | 916-652-0101
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PSY 22517
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PSY 22517
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License Number State | CA
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