Provider Demographics
NPI:1588617138
Name:BUCKINGHAM AND ASSOCIATES PC
Entity type:Organization
Organization Name:BUCKINGHAM AND ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MARSH
Authorized Official - Last Name:BUCKINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:317-288-9942
Mailing Address - Street 1:8202 CLEARVISTA PKWY STE 7
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1400
Mailing Address - Country:US
Mailing Address - Phone:317-288-9942
Mailing Address - Fax:317-288-9945
Practice Address - Street 1:8202 CLEARVISTA PKWY
Practice Address - Street 2:SUITE 6A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1400
Practice Address - Country:US
Practice Address - Phone:317-288-9942
Practice Address - Fax:317-288-9945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN57000069A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200121170Medicaid
IN179180Medicare ID - Type UnspecifiedMEDICARE ID