Provider Demographics
NPI:1033748470
Name:BUCKNER, MICHELE (LPC)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:DUFFY-BUCKNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:3412 FLAT CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-5873
Mailing Address - Country:US
Mailing Address - Phone:214-677-8684
Mailing Address - Fax:
Practice Address - Street 1:3412 FLAT CREEK DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-5873
Practice Address - Country:US
Practice Address - Phone:214-677-8684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59953101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional