Provider Demographics
NPI:1912436346
Name:BUCKLEY, MARY VICTORIA (MA, LPC)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:VICTORIA
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1312 17TH ST # 1117
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-1508
Mailing Address - Country:US
Mailing Address - Phone:720-257-9972
Mailing Address - Fax:720-295-3931
Practice Address - Street 1:1350 SPEER BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-2564
Practice Address - Country:US
Practice Address - Phone:720-257-9972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health