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General NPI Number Information
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NPI Number | 1023764057
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Entity Type | Individual
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Provider Name | KENYATTA BUFORD
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Gender | Male
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Dates
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Enumeration Date | 02/28/2022
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 2243 N MOUNTAIN AVE
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City | CLAREMONT
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State | CA
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Zip | 91711-1586
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Country | US
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Telephone | 909-371-6830
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Fax |
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Provider Business Mailing Address
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Address Line | 825 E MOBECK ST APT A
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City | WEST COVINA
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State | CA
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Zip | 91790-6708
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Country | US
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Telephone | 626-549-9970
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | ASW106197
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | A106197
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ASW106197
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License Number State | CA
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