Provider Demographics
NPI:1003469792
Name:BUCKINGHAM PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:BUCKINGHAM PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:907-744-1882
Mailing Address - Street 1:2401 E 42ND AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5228
Mailing Address - Country:US
Mailing Address - Phone:907-744-1882
Mailing Address - Fax:
Practice Address - Street 1:2401 E 42ND AVE STE 306
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5228
Practice Address - Country:US
Practice Address - Phone:907-744-1882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)