Basic Information
| Provider Information | |||||||||
| NPI: | 1790702694 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARKAWI-BUCK | ||||||||
| FirstName: | KAZARAN | ||||||||
| MiddleName: | GAYLA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA., LMFT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BARKAWI-BUCK | ||||||||
| OtherFirstName: | KASI | ||||||||
| OtherMiddleName: | GAYLA | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MA., LMFT | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5480 BALTIMORE DR | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919422020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196305113 | ||||||||
| FaxNumber: | 6193033306 | ||||||||
| Practice Location | |||||||||
| Address1: | 5480 BALTIMORE DR | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919422020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196305113 | ||||||||
| FaxNumber: | 6193033306 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2006 | ||||||||
| LastUpdateDate: | 06/29/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC 50604 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.