Healthcare Provider Details

I. General information

NPI: 1902393838
Provider Name (Legal Business Name): CHAYA M BUKIET LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5450 GLENRIDGE DR APT 313
ATLANTA GA
30342-4920
US

IV. Provider business mailing address

5450 GLENRIDGE DR APT 313
ATLANTA GA
30342-4920
US

V. Phone/Fax

Practice location:
  • Phone: 347-378-4123
  • Fax:
Mailing address:
  • Phone: 347-378-4123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: