Healthcare Provider Details

I. General information

NPI: 1174379622
Provider Name (Legal Business Name): BUCKNER PSYCHOTHERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10160 HIGHWAY 242 STE 8001008
CONROE TX
77385-4379
US

IV. Provider business mailing address

10160 HIGHWAY 242 STE 8001008
CONROE TX
77385-4379
US

V. Phone/Fax

Practice location:
  • Phone: 713-364-4380
  • Fax:
Mailing address:
  • Phone: 713-364-4380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLEY BUCKNER-MANLEY
Title or Position: PSYCHOTHERAPIST/OWNER
Credential: LPC
Phone: 936-661-1519