Provider Demographics
NPI:1144374828
Name:BASHORE, ELIZABETH FAHRNEY (MA, MFT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:FAHRNEY
Last Name:BASHORE
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:FAHRNEY
Other - Last Name:BASHORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, MFT
Mailing Address - Street 1:1270 LA PLAYA ST APT 105
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-1011
Mailing Address - Country:US
Mailing Address - Phone:415-680-5939
Mailing Address - Fax:
Practice Address - Street 1:80 EUREKA SQ STE 151
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-2603
Practice Address - Country:US
Practice Address - Phone:415-680-5939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 41811106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist