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NPI Code Detail

MEDICARE: BBK PSYCHOTHERAPEUTIC SERVICES, INC.

MEDICARE: BBK PSYCHOTHERAPEUTIC SERVICES, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMFC40764CA

General Provider Information

NPI Number : 1679872196
Entity Type Code : Organization
Provider Name (Legal Business Name) : BBK PSYCHOTHERAPEUTIC SERVICES, INC.
Provider Business Mailing Address
First Line : 501 N GOLDEN CIRCLE DR
Second Line : SUITE 100
City : SANTA ANA
State : CA
Zip : 92705-3913
Country : US
Telephone Number : 714-543-0483
Fax Number : 714-543-0483
Provider Business Practice Location Address
First Line : 501 N GOLDEN CIRCLE DR
Second Line : SUITE 100
City : SANTA ANA
State : CA
Zip : 92705-3913
Country : US
Telephone Number : 714-543-0483
Fax Number : 714-543-0483
Authorized Official
Title or Position : PRESIDENT
Name : MR. RICHARD BAUTZER
Credential : LMFT
Telephone Number : 714-543-0483
Provider Enumeration Date : 03/23/2011
Last Update Date : 09/12/2012

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Directions to “BBK PSYCHOTHERAPEUTIC SERVICES, INC. ” Practice Location

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