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General NPI Number Information
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NPI Number | 1942479852
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Entity Type | Organization
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Legal Business Name | K.C. BUGG, PSY.D., A PSYCHOLOGICAL CORPORATION
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Dates
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Enumeration Date | 02/25/2008
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Last Update Date | 08/29/2012
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Provider Practice Location Address
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Address Line | 446 S MARENGO AVE SUITE A
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City | PASADENA
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State | CA
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Zip | 91101-3113
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Country | US
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Telephone | 626-209-1194
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Fax |
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Provider Business Mailing Address
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Address Line | 446 S MARENGO AVE SUITE A
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City | PASADENA
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State | CA
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Zip | 91101-3113
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. K.C BUGG II
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Credential | PSY.D
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Telephone | 626-209-1194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY21273
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License Number State | CA
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