Provider Demographics
NPI:1659458628
Name:BUCKLEY, PAUL ALLEN (PAUL BUCKLEY, LMFT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ALLEN
Last Name:BUCKLEY
Suffix:
Gender:M
Credentials:PAUL BUCKLEY, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7515 WAYZATA BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1635
Mailing Address - Country:US
Mailing Address - Phone:612-867-2565
Mailing Address - Fax:952-928-2325
Practice Address - Street 1:7515 WAYZATA BLVD STE 209
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-1635
Practice Address - Country:US
Practice Address - Phone:612-867-2565
Practice Address - Fax:952-928-2325
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1001101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health