Provider Demographics
NPI:1033233457
Name:BUNTIC, JAZMIN CATALINA (LMFT)
Entity Type:Individual
Prefix:
First Name:JAZMIN
Middle Name:CATALINA
Last Name:BUNTIC
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JAZMIN
Other - Middle Name:CATALINA
Other - Last Name:MAHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:2170 STEVENS CREEK BLVD
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95015
Mailing Address - Country:US
Mailing Address - Phone:408-236-2238
Mailing Address - Fax:408-236-2238
Practice Address - Street 1:20863 STEVENS CREEK BLVD
Practice Address - Street 2:SUITE 580
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2113
Practice Address - Country:US
Practice Address - Phone:408-236-2238
Practice Address - Fax:408-236-2238
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 40045106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist