Provider Demographics
NPI:1760248181
Name:BUCKNER, KATHERYN (LPC-A)
Entity Type:Individual
Prefix:
First Name:KATHERYN
Middle Name:
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:KATHERYN
Other - Middle Name:
Other - Last Name:KIKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC-A
Mailing Address - Street 1:9404 GAULDING RD
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77705-9434
Mailing Address - Country:US
Mailing Address - Phone:409-234-4144
Mailing Address - Fax:
Practice Address - Street 1:9404 GAULDING RD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77705-9434
Practice Address - Country:US
Practice Address - Phone:409-234-4144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93015101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional