Basic Information
| Provider Information | |||||||||
| NPI: | 1124472576 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUIKEMA | ||||||||
| FirstName: | BRADLEY | ||||||||
| MiddleName: | W. | ||||||||
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| Credential: | M.A., LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1333 IRIS AVE. | ||||||||
| Address2: | MENTAL HEALTH PARTNERS OF BOULDER COUNTY | ||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 803045449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034438500 | ||||||||
| FaxNumber: | 3034496029 | ||||||||
| Practice Location | |||||||||
| Address1: | 1333 IRIS AVE. | ||||||||
| Address2: | MENTAL HEALTH PARTNERS OF BOULDER COUNTY | ||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 803045449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034438500 | ||||||||
| FaxNumber: | 3034496029 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2016 | ||||||||
| LastUpdateDate: | 05/23/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFT.0001228 | CO | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.