Healthcare Provider Details

I. General information

NPI: 1558144915
Provider Name (Legal Business Name): KEVIN RICHARD BUDD MS, LLC, MT-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 FIVEPOINT
IRVINE CA
92618-2377
US

IV. Provider business mailing address

10602 KEDGE AVE
GARDEN GROVE CA
92843-5322
US

V. Phone/Fax

Practice location:
  • Phone: 268-414-6846
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number156140
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number13115
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451024458
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: