Provider Demographics
NPI:1295168656
Name:BUCKNER, NEAL CHARLES (CCHT, MNLP)
Entity type:Individual
Prefix:MR
First Name:NEAL
Middle Name:CHARLES
Last Name:BUCKNER
Suffix:
Gender:M
Credentials:CCHT, MNLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 33RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-2820
Mailing Address - Country:US
Mailing Address - Phone:360-688-3092
Mailing Address - Fax:
Practice Address - Street 1:1020 33RD AVE NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-2820
Practice Address - Country:US
Practice Address - Phone:360-688-3092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-20
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHP61287636101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health