Provider Demographics
NPI:1164936662
Name:BUCKSTEN, SARA ELAINE (LMFT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ELAINE
Last Name:BUCKSTEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 W CARMEL DR STE 120
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5501
Mailing Address - Country:US
Mailing Address - Phone:317-569-5433
Mailing Address - Fax:317-569-1767
Practice Address - Street 1:615 W CARMEL DR STE 120
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5501
Practice Address - Country:US
Practice Address - Phone:317-569-5433
Practice Address - Fax:317-569-1767
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001989A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist