Provider Demographics
NPI:1902168685
Name:BASTANI, PATRICIA JEAN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:JEAN
Last Name:BASTANI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 E NORTHERN LIGHTS BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2730
Mailing Address - Country:US
Mailing Address - Phone:907-310-0755
Mailing Address - Fax:907-802-6290
Practice Address - Street 1:207 E NORTHERN LIGHTS BLVD STE 120
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2730
Practice Address - Country:US
Practice Address - Phone:907-310-0755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK753101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional