Provider Demographics
NPI:1942479852
Name:K.C. BUGG, PSY.D., A PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:K.C. BUGG, PSY.D., A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:K.C
Authorized Official - Middle Name:
Authorized Official - Last Name:BUGG
Authorized Official - Suffix:II
Authorized Official - Credentials:PSYD
Authorized Official - Phone:626-209-1194
Mailing Address - Street 1:446 S MARENGO AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-3113
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:446 S MARENGO AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3113
Practice Address - Country:US
Practice Address - Phone:626-209-1194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21273103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty