Provider Demographics
NPI:1225594195
Name:BUCKLEY, MICHAEL M (MA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:M
Last Name:BUCKLEY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 9TH ST APT C301
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6010
Mailing Address - Country:US
Mailing Address - Phone:425-372-8622
Mailing Address - Fax:206-770-6115
Practice Address - Street 1:10512 NE 68TH ST STE 202
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-7063
Practice Address - Country:US
Practice Address - Phone:425-372-8622
Practice Address - Fax:206-770-6115
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60899625101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health