Provider Demographics
NPI:1477717775
Name:BUCKNERBOONE, EUNICE MARIE (MS,LCPC,LPHA)
Entity Type:Individual
Prefix:MS
First Name:EUNICE
Middle Name:MARIE
Last Name:BUCKNERBOONE
Suffix:
Gender:F
Credentials:MS,LCPC,LPHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 N RANDOLPH ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3949
Mailing Address - Country:US
Mailing Address - Phone:217-355-0825
Mailing Address - Fax:217-355-1466
Practice Address - Street 1:206 N RANDOLPH ST
Practice Address - Street 2:SUITE 405
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3949
Practice Address - Country:US
Practice Address - Phone:217-355-0825
Practice Address - Fax:217-355-1466
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006788101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional