Provider Demographics
NPI:1174928402
Name:BAYLE, JENNIFER CATHRIN (MFTI)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:CATHRIN
Last Name:BAYLE
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:CATHRIN
Other - Last Name:GONZALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17130 SEQUOIA ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345
Mailing Address - Country:US
Mailing Address - Phone:760-985-0646
Mailing Address - Fax:760-995-3119
Practice Address - Street 1:17130 SEQUOIA ST
Practice Address - Street 2:SUITE 106
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345
Practice Address - Country:US
Practice Address - Phone:760-985-0646
Practice Address - Fax:760-995-3119
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF83100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health