Provider Demographics
NPI:1578141354
Name:BUCKLEY, ELIZABETH A (LMFT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13018 VALLEYHEART DR APT 3
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-1993
Mailing Address - Country:US
Mailing Address - Phone:805-433-4133
Mailing Address - Fax:
Practice Address - Street 1:13018 VALLEYHEART DR APT 3
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-1993
Practice Address - Country:US
Practice Address - Phone:805-433-4133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA125083101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health