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General NPI Number Information
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NPI Number | 1073579926
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Entity Type | Organization
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Legal Business Name | BUCKELEW PROGRAMS
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 201 ALAMEDA DEL PRADO SUITE 201
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City | NOVATO
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State | CA
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Zip | 94949-6698
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Country | US
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Telephone | 415-457-1925
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Fax |
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Provider Business Mailing Address
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Address Line | 201 ALAMEDA DEL PRADO SUITE 201
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City | NOVATO
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State | CA
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Zip | 94949-6698
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Country | US
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Telephone | 415-457-1925
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CHRIS KUGHN
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Credential | LMFT
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Telephone | 415-457-6964
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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