Provider Demographics
NPI:1952603094
Name:BADER, CHRISTIN MARIE (MFT)
Entity type:Individual
Prefix:MRS
First Name:CHRISTIN
Middle Name:MARIE
Last Name:BADER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 SYRACUSE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-6256
Mailing Address - Country:US
Mailing Address - Phone:916-705-8274
Mailing Address - Fax:916-471-0228
Practice Address - Street 1:5701 LONETREE BLVD STE 204E
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-3794
Practice Address - Country:US
Practice Address - Phone:916-705-8274
Practice Address - Fax:916-471-0228
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86957106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist