Provider Demographics
NPI:1891847307
Name:BAYO, PABLO (MA)
Entity type:Individual
Prefix:
First Name:PABLO
Middle Name:
Last Name:BAYO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 469
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95502-0469
Mailing Address - Country:US
Mailing Address - Phone:707-228-0943
Mailing Address - Fax:
Practice Address - Street 1:2259 MYRTLE AVE
Practice Address - Street 2:CHANGING TIDES FAMILY SERVICES
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3325
Practice Address - Country:US
Practice Address - Phone:707-444-8293
Practice Address - Fax:707-444-8298
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF # 56524106H00000X
RI391101YM0800X
CAIMF56524101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist