Provider Demographics
NPI:1679872196
Name:BBK PSYCHOTHERAPEUTIC SERVICES, INC.
Entity type:Organization
Organization Name:BBK PSYCHOTHERAPEUTIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUTZER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:714-543-0483
Mailing Address - Street 1:501 N GOLDEN CIRCLE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3913
Mailing Address - Country:US
Mailing Address - Phone:714-543-0483
Mailing Address - Fax:714-543-0483
Practice Address - Street 1:501 N GOLDEN CIRCLE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3913
Practice Address - Country:US
Practice Address - Phone:714-543-0483
Practice Address - Fax:714-543-0483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-23
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40764106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty