Provider Demographics
NPI:1174379622
Name:BUCKNER PSYCHOTHERAPY, PLLC
Entity type:Organization
Organization Name:BUCKNER PSYCHOTHERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKNER-MANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:936-367-4100
Mailing Address - Street 1:1095 EVERGREEN CIR STE 221
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3646
Mailing Address - Country:US
Mailing Address - Phone:936-367-4100
Mailing Address - Fax:936-253-1230
Practice Address - Street 1:1095 EVERGREEN CIR STE 221
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3646
Practice Address - Country:US
Practice Address - Phone:936-367-4100
Practice Address - Fax:936-253-1230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-25
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty