Provider Demographics
NPI:1265701411
Name:BUCKALOO, BOBBY J (LPC)
Entity type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:J
Last Name:BUCKALOO
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:BJ
Other - Middle Name:
Other - Last Name:BUCKALOO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:17200 MCGAHEY RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:OK
Mailing Address - Zip Code:73439-5530
Mailing Address - Country:US
Mailing Address - Phone:580-564-6034
Mailing Address - Fax:
Practice Address - Street 1:17200 MCGAHEY RD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:OK
Practice Address - Zip Code:73439-5530
Practice Address - Country:US
Practice Address - Phone:580-564-6034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-16
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLPC5878101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health