Provider Demographics
NPI:1639618101
Name:MEGAN K. BUCKLIN, LCPC, P.C.
Entity Type:Organization
Organization Name:MEGAN K. BUCKLIN, LCPC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:815-935-5540
Mailing Address - Street 1:19 HERITAGE DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1369
Mailing Address - Country:US
Mailing Address - Phone:815-935-5540
Mailing Address - Fax:866-507-7385
Practice Address - Street 1:19 HERITAGE DR
Practice Address - Street 2:SUITE 208
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1369
Practice Address - Country:US
Practice Address - Phone:815-935-5540
Practice Address - Fax:866-507-7385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060.011928251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health