Provider Demographics
NPI:1588343669
Name:BUCKIUS, MICHAEL (MFA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:BUCKIUS
Suffix:
Gender:M
Credentials:MFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7638 N 12TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4501
Mailing Address - Country:US
Mailing Address - Phone:602-303-1224
Mailing Address - Fax:
Practice Address - Street 1:5040 E SHEA BLVD STE 164
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4686
Practice Address - Country:US
Practice Address - Phone:480-641-1165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health