Provider Demographics
NPI:1922652866
Name:BUCKALEW, RACHEL (LPC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:BUCKALEW
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 1:4207 SW 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-5303
Mailing Address - Country:US
Mailing Address - Phone:806-206-9745
Mailing Address - Fax:806-310-2660
Practice Address - Street 1:3601 S. GEORGIA
Practice Address - Street 2:SUITE C-2
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-4800
Practice Address - Country:US
Practice Address - Phone:806-206-9745
Practice Address - Fax:806-310-2660
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-29
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77137101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX400909401Medicaid