Healthcare Provider Details

I. General information

NPI: 1538142096
Provider Name (Legal Business Name): LINDA G BUCKLAND LMHC CCMHC NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 MOUNTAIN DRIVE SUITE 106
DESTIN FL
32541-2346
US

IV. Provider business mailing address

215 MOUNTAIN DRIVE SUITE 106
DESTIN FL
32541-2346
US

V. Phone/Fax

Practice location:
  • Phone: 850-837-9100
  • Fax: 850-837-3774
Mailing address:
  • Phone: 850-837-9100
  • Fax: 850-837-3774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH2636
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: