Provider Demographics
NPI:1245759885
Name:BUCKLES, WHITNI (PHD, MA)
Entity Type:Individual
Prefix:DR
First Name:WHITNI
Middle Name:
Last Name:BUCKLES
Suffix:
Gender:F
Credentials:PHD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6044 W NAUTICA BLVD
Mailing Address - Street 2:
Mailing Address - City:MCCORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46055-9265
Mailing Address - Country:US
Mailing Address - Phone:765-748-0810
Mailing Address - Fax:
Practice Address - Street 1:7526 E 82ND ST STE 150
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1492
Practice Address - Country:US
Practice Address - Phone:317-585-1060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14694101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health