Healthcare Provider Details

I. General information

NPI: 1629144829
Provider Name (Legal Business Name): JAMES THOMAS BUCKLEY PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 OLIVE ST SUITE 306
EUGENE OR
97401
US

IV. Provider business mailing address

576 OLIVE ST SUITE 307
EUGENE OR
97401
US

V. Phone/Fax

Practice location:
  • Phone: 541-344-7303
  • Fax: 541-686-6283
Mailing address:
  • Phone: 541-344-7303
  • Fax: 541-606-6283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1169
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier037759
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: