Provider Demographics
NPI:1710081245
Name:BUCKLEY, CALVIN EUGENE (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:EUGENE
Last Name:BUCKLEY
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4617 MONTROSE BLVD STE C207
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-6151
Mailing Address - Country:US
Mailing Address - Phone:713-624-0453
Mailing Address - Fax:
Practice Address - Street 1:4617 MONTROSE BLVD STE C207
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-6151
Practice Address - Country:US
Practice Address - Phone:713-624-0453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19041101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional