Provider Demographics
NPI:1639588130
Name:BUCKLEY, SCOTT (NCSP)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:BUCKLEY
Suffix:
Gender:M
Credentials:NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 E STANTON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1322
Mailing Address - Country:US
Mailing Address - Phone:614-203-7476
Mailing Address - Fax:
Practice Address - Street 1:1545 HUY RD
Practice Address - Street 2:COLUMBUS HEARING IMPAIRED PROGRAM
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-3531
Practice Address - Country:US
Practice Address - Phone:614-365-5977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH1357249103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool