Provider Demographics
NPI:1679732390
Name:EARLEY, BOBBI JEAN
Entity type:Individual
Prefix:
First Name:BOBBI
Middle Name:JEAN
Last Name:EARLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 MISSOURI ST
Mailing Address - Street 2:SUITE 203E
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-6088
Mailing Address - Country:US
Mailing Address - Phone:707-425-9670
Mailing Address - Fax:707-425-9880
Practice Address - Street 1:1125 MISSOURI ST
Practice Address - Street 2:SUITE 203E
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6088
Practice Address - Country:US
Practice Address - Phone:707-425-9670
Practice Address - Fax:707-425-9880
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor