Provider Demographics
NPI:1962851451
Name:BUCKNER, BRITTANY (LCPC)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:
Other - Last Name:HOPF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:3504 W EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60651-2220
Mailing Address - Country:US
Mailing Address - Phone:920-207-7476
Mailing Address - Fax:
Practice Address - Street 1:3860 W OGDEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-2460
Practice Address - Country:US
Practice Address - Phone:872-588-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009497101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180009497OtherSTATE LICENSE