Active NPI
Osun Toki Banjoko
- Mental Health Counselor
- Richmond, CA
National Provider Identifier
1144384058
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- PSB#31955
- Practice address
- 3219 Pierce St
Richmond, CA 94804-5910 - Phone
- (510) 559-5550
- NPI assigned
- Dec 22, 2006
- Last updated
- Sep 10, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | PSB#31955 | CA | |
| Mental Health Counselor | 101YM0800X | PSB#31955 | CA | Primary |
| Clinical Child & Adolescent Psychologist | 103TC2200X | NU |
Addresses
Primary practice location
3219 Pierce St
Richmond, CA 94804-5910
Mailing address
3219 Pierce St
Richmond, CA 94804-5910
Phone (510) 559-5550
Other names 1
- Mr. Danny Mitchell Bagley
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSB#31955 | CA | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bay Area Community Resources, Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Community/Behavioral Health Agency
- El Cerrito, CA
- NPI 1356478143
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1441843200000",
"number": "1144384058",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3219 PIERCE ST",
"city": "RICHMOND",
"state": "CA",
"postal_code": "948045910",
"telephone_number": "510-559-5550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3219 PIERCE ST",
"city": "RICHMOND",
"state": "CA",
"postal_code": "948045910",
"telephone_number": "510-559-5550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANJOKO",
"first_name": "OSUN",
"middle_name": "TOKI",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-22",
"last_updated": "2015-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "CA",
"license": "PSB#31955",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "PSB#31955",
"primary": true
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "DANNY",
"last_name": "BAGLEY",
"middle_name": "MITCHELL",
"prefix": "MR.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Richmond, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.