Provider Demographics
NPI:1093297780
Name:BUCKLEY, ERONILDE CHAVES (MA, LPC, LAC, NCC)
Entity Type:Individual
Prefix:
First Name:ERONILDE
Middle Name:CHAVES
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:MA, LPC, LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 E CHEYENNE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-2535
Mailing Address - Country:US
Mailing Address - Phone:719-359-3431
Mailing Address - Fax:
Practice Address - Street 1:108 E CHEYENNE RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-2504
Practice Address - Country:US
Practice Address - Phone:719-359-3431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0014711101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional