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Contact Information

VANESSA BAUTISTA
5253 10TH ARMORED LOOP
FORT MOORE, GA31905-7088
 Phone: 831-245-8662
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

School

103TS0200X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for VANESSA BAUTISTA · (Female)

NPI # 1588485825
Status Active
Credentials
Entity Individual
Enumeration date 10/19/2024
Last updated 10/19/2024 - More than a year ago
Sole proprietor 1 Yes
Identifiers
  • TX License # 72067
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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