Provider Demographics
NPI:1801318092
Name:BUCKNER, STACIA B (LMFT, NCC)
Entity type:Individual
Prefix:MRS
First Name:STACIA
Middle Name:B
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:LMFT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210B GILMORE DR
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-6710
Mailing Address - Country:US
Mailing Address - Phone:615-934-1092
Mailing Address - Fax:
Practice Address - Street 1:1205 4TH ST
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-3707
Practice Address - Country:US
Practice Address - Phone:305-834-0867
Practice Address - Fax:305-292-6723
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3382106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist