Provider Demographics
NPI:1821409103
Name:BUCKLES, CAROLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:
Last Name:BUCKLES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:CAROLE
Other - Middle Name:ANNE
Other - Last Name:BRUNNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:315 S COLLEGE ROAD
Mailing Address - Street 2:SUITE 260 MAILBOX 26
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3221
Mailing Address - Country:US
Mailing Address - Phone:833-782-2253
Mailing Address - Fax:318-232-6932
Practice Address - Street 1:315 S COLLEGE ROAD
Practice Address - Street 2:SUITE 260
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3221
Practice Address - Country:US
Practice Address - Phone:833-782-2253
Practice Address - Fax:318-232-6932
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA981103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical