Provider Demographics
NPI:1386945467
Name:BACHRACH, MARC
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:BACHRACH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 143RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-5161
Mailing Address - Country:US
Mailing Address - Phone:425-786-6800
Mailing Address - Fax:
Practice Address - Street 1:1715 114TH AVE SE
Practice Address - Street 2:SUITE 208
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6945
Practice Address - Country:US
Practice Address - Phone:425-786-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60159958106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist