Provider Demographics
NPI:1588114938
Name:SONYA BUKIRK
Entity type:Organization
Organization Name:SONYA BUKIRK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BUSKIRK
Authorized Official - Suffix:
Authorized Official - Credentials:LMHP
Authorized Official - Phone:308-293-1385
Mailing Address - Street 1:3507 D AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-3055
Mailing Address - Country:US
Mailing Address - Phone:308-293-1385
Mailing Address - Fax:
Practice Address - Street 1:124 W 46TH ST
Practice Address - Street 2:SUITE #204
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-8348
Practice Address - Country:US
Practice Address - Phone:308-293-1385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2808101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025857400Medicaid