Provider Demographics
NPI:1700139615
Name:BUFFALOE, MEKEISHA SHAWN (MFTI)
Entity Type:Individual
Prefix:
First Name:MEKEISHA
Middle Name:SHAWN
Last Name:BUFFALOE
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1459 TREAT BLVD
Mailing Address - Street 2:APT. 615
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-7503
Mailing Address - Country:US
Mailing Address - Phone:951-837-3865
Mailing Address - Fax:
Practice Address - Street 1:237 RACE ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-4823
Practice Address - Country:US
Practice Address - Phone:408-971-9822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 62475106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist