Healthcare Provider Details

I. General information

NPI: 1598532798
Provider Name (Legal Business Name): VINCENT BUHAGIAR LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2023
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 CLAYTON RD STE 203
CONCORD CA
94519-2732
US

IV. Provider business mailing address

3125 CLAYTON RD STE 203
CONCORD CA
94519-2732
US

V. Phone/Fax

Practice location:
  • Phone: 339-337-3729
  • Fax:
Mailing address:
  • Phone: 339-337-3729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number126503
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: