Provider Demographics
NPI:1962958280
Name:BUCKMASTER, WILLIAM MATTHEW (LCDC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MATTHEW
Last Name:BUCKMASTER
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 COUNTRY RD. 36
Mailing Address - Street 2:14103 TIMBER BLUFF DR. PEARLAND TX 77584
Mailing Address - City:ANGELTON
Mailing Address - State:TX
Mailing Address - Zip Code:77515
Mailing Address - Country:US
Mailing Address - Phone:409-382-9295
Mailing Address - Fax:
Practice Address - Street 1:1820 COUNTY ROAD 36
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-8727
Practice Address - Country:US
Practice Address - Phone:409-382-9295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11580101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11580OtherLCDC LICENSE NUMBER