Provider Demographics
NPI:1437400793
Name:BASHFUL ELEPHANT
Entity Type:Organization
Organization Name:BASHFUL ELEPHANT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:F PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUFFALOE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:559-326-8391
Mailing Address - Street 1:BASHFUL ELEPHANT
Mailing Address - Street 2:3097 WILLOW SUITE 4
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612
Mailing Address - Country:US
Mailing Address - Phone:559-326-8391
Mailing Address - Fax:
Practice Address - Street 1:3097 WILLOW SUITE 4
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612
Practice Address - Country:US
Practice Address - Phone:559-326-8391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC50672101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty