Provider Demographics
NPI:1851883565
Name:BUCKNER, ANNA MICHELLE (LPC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MICHELLE
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 711
Mailing Address - Street 2:
Mailing Address - City:BOLTON
Mailing Address - State:MS
Mailing Address - Zip Code:39041-0711
Mailing Address - Country:US
Mailing Address - Phone:662-418-7785
Mailing Address - Fax:
Practice Address - Street 1:1635 LELIA DR STE 100
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4876
Practice Address - Country:US
Practice Address - Phone:601-362-7020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2279101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional