Provider Demographics
NPI:1295197333
Name:BUCKLEY, LAWRENCE GRAHAM JR (CDP)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:GRAHAM
Last Name:BUCKLEY
Suffix:JR
Gender:M
Credentials:CDP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:P O BOX 12598
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201
Mailing Address - Country:US
Mailing Address - Phone:425-248-4900
Mailing Address - Fax:425-248-4703
Practice Address - Street 1:3810 196TH ST SW STE 11
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5746
Practice Address - Country:US
Practice Address - Phone:425-248-4900
Practice Address - Fax:425-248-4703
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00004052101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)