Provider Demographics
NPI:1679724173
Name:BUDDE, YASHICA W (LMFT)
Entity type:Individual
Prefix:MRS
First Name:YASHICA
Middle Name:W
Last Name:BUDDE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31225 LA BAYA DR
Mailing Address - Street 2:SUITE #115
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-7337
Mailing Address - Country:US
Mailing Address - Phone:818-807-6274
Mailing Address - Fax:818-851-9139
Practice Address - Street 1:31225 LA BAYA DR
Practice Address - Street 2:SUITE #115
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-7337
Practice Address - Country:US
Practice Address - Phone:818-807-6274
Practice Address - Fax:818-851-9139
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54019106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA225400000XOtherMEDI-CAL
CA57089OtherMEDI-CAL