Healthcare Provider Details

I. General information

NPI: 1023254992
Provider Name (Legal Business Name): THAO PHUONG BUI MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2008
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1174 CASTRO ST
MOUNTAIN VIEW CA
94040-2568
US

IV. Provider business mailing address

2295 CALIFORNIA ST APT 27
SAN FRANCISCO CA
94115-2860
US

V. Phone/Fax

Practice location:
  • Phone: 650-512-8695
  • Fax:
Mailing address:
  • Phone: 619-400-7038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number105105
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: