Healthcare Provider Details

I. General information

NPI: 1841660552
Provider Name (Legal Business Name): CHELSEA BUCINA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 E BROADWAY STE 810
EUGENE OR
97401-3160
US

IV. Provider business mailing address

325 2ND ST APT 416
LAKE OSWEGO OR
97034-3288
US

V. Phone/Fax

Practice location:
  • Phone: 541-357-9433
  • Fax:
Mailing address:
  • Phone: 971-341-2340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3351
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: