Provider Demographics
NPI:1790702694
Name:BARKAWI-BUCK, KAZARAN GAYLA (MA, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:KAZARAN
Middle Name:GAYLA
Last Name:BARKAWI-BUCK
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:MRS
Other - First Name:KASI
Other - Middle Name:GAYLA
Other - Last Name:BARKAWI-BUCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:5480 BALTIMORE DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-2020
Mailing Address - Country:US
Mailing Address - Phone:619-630-5113
Mailing Address - Fax:619-303-3306
Practice Address - Street 1:5480 BALTIMORE DR
Practice Address - Street 2:SUITE 250
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-2020
Practice Address - Country:US
Practice Address - Phone:619-630-5113
Practice Address - Fax:619-303-3306
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 50604106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist