Provider Demographics
NPI:1659588804
Name:BUCKLEY, MATTHEW REED (EDD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:REED
Last Name:BUCKLEY
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1713 DEERING ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-2934
Mailing Address - Country:US
Mailing Address - Phone:662-843-1324
Mailing Address - Fax:662-846-4549
Practice Address - Street 1:HIGHWAY 8 EWING 337
Practice Address - Street 2:DELTA STATE UNIVERSITY
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38733
Practice Address - Country:US
Practice Address - Phone:662-846-4357
Practice Address - Fax:662-846-4549
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMSLPC0624101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health