Provider Demographics
NPI:1134323207
Name:ANTONIK-BUXTON, URSULA DOROTA (MFT)
Entity Type:Individual
Prefix:MRS
First Name:URSULA
Middle Name:DOROTA
Last Name:ANTONIK-BUXTON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 842
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:96008-0842
Mailing Address - Country:US
Mailing Address - Phone:530-605-3221
Mailing Address - Fax:530-410-6995
Practice Address - Street 1:1647 HARTNELL AVE.
Practice Address - Street 2:SUITE 14
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2268
Practice Address - Country:US
Practice Address - Phone:530-605-3221
Practice Address - Fax:530-410-6995
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA49881106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist