Provider Demographics
NPI:1609264118
Name:BUCKLEY, NICOLE RAE (LMFT)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:RAE
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MISS
Other - First Name:NIKKI
Other - Middle Name:
Other - Last Name:BUCKLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:27281 LAS RAMBLAS
Mailing Address - Street 2:#200
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6324
Mailing Address - Country:US
Mailing Address - Phone:949-751-7312
Mailing Address - Fax:
Practice Address - Street 1:27281 LAS RAMBLAS
Practice Address - Street 2:#200
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6324
Practice Address - Country:US
Practice Address - Phone:949-751-7312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83793106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist