Provider Demographics
NPI:1154046134
Name:NORTH BAY PSYCHOTHERAPY SERVICES
Entity type:Organization
Organization Name:NORTH BAY PSYCHOTHERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:FORNES
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:714-713-3890
Mailing Address - Street 1:620 STATE ST UNIT 421
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-6725
Mailing Address - Country:US
Mailing Address - Phone:714-713-3890
Mailing Address - Fax:
Practice Address - Street 1:620 STATE ST UNIT 421
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-6725
Practice Address - Country:US
Practice Address - Phone:714-713-3890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty