Healthcare Provider Details

I. General information

NPI: 1760627632
Provider Name (Legal Business Name): PATRICIA LYNN VANBUSKIRK MA, MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2008
Last Update Date: 12/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 ERRINGER RD SUITE 207
SIMI VALLEY CA
93065-3583
US

IV. Provider business mailing address

1633 ERRINGER RD SUITE 207
SIMI VALLEY CA
93065-3583
US

V. Phone/Fax

Practice location:
  • Phone: 805-578-2425
  • Fax:
Mailing address:
  • Phone: 805-578-2425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number40573
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: