Healthcare Provider Details

I. General information

NPI: 1548533904
Provider Name (Legal Business Name): GARY FRANK BUBASH LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2012
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 QUAIL CT STE 213
WALNUT CREEK CA
94596-8702
US

IV. Provider business mailing address

1722 HOLLAND DR
WALNUT CREEK CA
94597-2241
US

V. Phone/Fax

Practice location:
  • Phone: 510-224-3343
  • Fax:
Mailing address:
  • Phone: 415-328-1267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT94894
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: