Provider Demographics
NPI:1467758268
Name:BUCKNER, ANDREW MICHAEL (MA LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:MICHAEL
Last Name:BUCKNER
Suffix:
Gender:M
Credentials:MA LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 E OLDHAM AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-5567
Mailing Address - Country:US
Mailing Address - Phone:865-523-9163
Mailing Address - Fax:865-525-2958
Practice Address - Street 1:816 E OLDHAM AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-5567
Practice Address - Country:US
Practice Address - Phone:865-523-9163
Practice Address - Fax:865-525-2958
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3520101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ016810Medicaid