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JOHN KENNETH BUKENBERGER MFT
Mental Health >> Counselor >> Behavioral Health & Social Service ProvidersRegistrant NPI Number: 1871646497
Individual Registrant: JOHN KENNETH BUKENBERGER MFT
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
52 N TU SU LN BISHOP, CA 93514-8058 US
Tel: 760-873-6394 Fax: 760-873-3254
Tel: 760-873-6394 Fax: 760-873-3254
Contact information for business:
PO BOX 7979 MAMMOTH LAKES, CA 93546-7979 US
Tel: 760-935-4957 Fax: --
Tel: 760-935-4957 Fax: --
Registration Information:
NPI: 1871646497
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 101YM0800X | Behavioral Health & Social Service Providers Counselor Mental Health | CA | MFC24829 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| ORGANIZATION NPI NUMBER | 1659433191 | CA | 01 |
