Provider Demographics
NPI:1073579926
Name:BUCKELEW PROGRAMS
Entity Type:Organization
Organization Name:BUCKELEW PROGRAMS
Other - Org Name:BUCKELEW PROGRAMS - MAIL
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:415-457-6964
Mailing Address - Street 1:201 ALAMEDA DEL PRADO
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-6698
Mailing Address - Country:US
Mailing Address - Phone:415-457-1925
Mailing Address - Fax:
Practice Address - Street 1:201 ALAMEDA DEL PRADO
Practice Address - Street 2:SUITE 201
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-6698
Practice Address - Country:US
Practice Address - Phone:415-457-1925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251B00000X
CA210102749320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness