Provider Demographics
NPI:1053433847
Name:FACKLER, ROXANNE MARIE (MARRIAGE AND FAMILY)
Entity type:Individual
Prefix:MS
First Name:ROXANNE
Middle Name:MARIE
Last Name:FACKLER
Suffix:
Gender:F
Credentials:MARRIAGE AND FAMILY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12200
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93389
Mailing Address - Country:US
Mailing Address - Phone:661-333-1603
Mailing Address - Fax:661-395-0588
Practice Address - Street 1:1522 18TH ST
Practice Address - Street 2:STE 210
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-4448
Practice Address - Country:US
Practice Address - Phone:661-327-5827
Practice Address - Fax:661-395-0588
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC24890106H00000X
ORT0505106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist