Provider Demographics
NPI:1851449177
Name:BARBASTE, JORGE O (LMFT)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:O
Last Name:BARBASTE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 LONE TREE WAY STE A1
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-6000
Mailing Address - Country:US
Mailing Address - Phone:925-756-1334
Mailing Address - Fax:
Practice Address - Street 1:3725 LONE TREE WAY STE A1
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6000
Practice Address - Country:US
Practice Address - Phone:925-756-1334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 38822106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist