Healthcare Provider Details

I. General information

NPI: 1609040161
Provider Name (Legal Business Name): JOY ANN BUCKLEY LPC LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS JOY ANN MEYERS

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 10/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1761 COUNTY ROAD 5
DIVIDE CO
80814-9101
US

IV. Provider business mailing address

1761 COUNTY ROAD 5
DIVIDE CO
80814-9101
US

V. Phone/Fax

Practice location:
  • Phone: 719-200-7209
  • Fax: 719-687-9668
Mailing address:
  • Phone: 719-200-7209
  • Fax: 719-687-9668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC 5789
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD 259
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: