Provider Demographics
NPI:1952146904
Name:BUCKLEW, STEPHANIE (RMHCI)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BUCKLEW
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:SCHANDLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3890 E STATE ROAD 64
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-9040
Mailing Address - Country:US
Mailing Address - Phone:941-741-3575
Mailing Address - Fax:
Practice Address - Street 1:3890 E STATE ROAD 64
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-9040
Practice Address - Country:US
Practice Address - Phone:941-741-3575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25469101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health