Provider Demographics
NPI:1609040161
Name:BUCKLEY, JOY ANN (LPC LAC)
Entity Type:Individual
Prefix:MRS
First Name:JOY
Middle Name:ANN
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:LPC LAC
Other - Prefix:MISS
Other - First Name:JOY
Other - Middle Name:ANN
Other - Last Name:MEYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1761 COUNTY ROAD 5
Mailing Address - Street 2:
Mailing Address - City:DIVIDE
Mailing Address - State:CO
Mailing Address - Zip Code:80814-9101
Mailing Address - Country:US
Mailing Address - Phone:719-200-7209
Mailing Address - Fax:719-687-9668
Practice Address - Street 1:1761 COUNTY ROAD 5
Practice Address - Street 2:
Practice Address - City:DIVIDE
Practice Address - State:CO
Practice Address - Zip Code:80814-9101
Practice Address - Country:US
Practice Address - Phone:719-200-7209
Practice Address - Fax:719-687-9668
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC 5789101YM0800X
COACD 259101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health