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General NPI Number Information
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NPI Number | 1750699591
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Entity Type | Individual
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Provider Name | KIMBERLY KAY BUKSA MA
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Gender | Female
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Dates
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Enumeration Date | 09/14/2010
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Last Update Date | 09/07/2016
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Provider Practice Location Address
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Address Line | 5 KELLER ST SUITE D
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City | PETALUMA
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State | CA
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Zip | 94952-2349
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Country | US
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Telephone | 707-776-6414
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Fax |
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Provider Business Mailing Address
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Address Line | 314 BOND AVE
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City | PETALUMA
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State | CA
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Zip | 94954-5647
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Country | US
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Telephone | 415-623-9514
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 92609
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License Number State | CA
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