Provider Demographics
NPI:1427269315
Name:B&A PROFESSIONAL SERVICCES
Entity type:Organization
Organization Name:B&A PROFESSIONAL SERVICCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:TRACY
Authorized Official - Last Name:BAXT
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:909-518-0329
Mailing Address - Street 1:750 TERRADO PLZ STE 40
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3445
Mailing Address - Country:US
Mailing Address - Phone:626-332-0556
Mailing Address - Fax:
Practice Address - Street 1:150 N. GRAND AVE. SUITE 212
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790
Practice Address - Country:US
Practice Address - Phone:626-915-2110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT20764106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty