Healthcare Provider Details

I. General information

NPI: 1841129715
Provider Name (Legal Business Name): MICHAEL BUCKLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8178 JACKSON RD
ANN ARBOR MI
48103-9806
US

IV. Provider business mailing address

24438 SUMMER LN
FLAT ROCK MI
48134-1835
US

V. Phone/Fax

Practice location:
  • Phone: 734-802-1128
  • Fax:
Mailing address:
  • Phone: 734-991-5836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4151001221
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: