Provider Demographics
NPI:1154530608
Name:BUCKLEY, LINDA G (MFT)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:G
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32350 NAMELESS LANE
Mailing Address - Street 2:
Mailing Address - City:FT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437
Mailing Address - Country:US
Mailing Address - Phone:707-964-6680
Mailing Address - Fax:
Practice Address - Street 1:247 N MAIN ST
Practice Address - Street 2:STE J
Practice Address - City:FT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437
Practice Address - Country:US
Practice Address - Phone:707-964-7236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35067106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist