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General NPI Number Information
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NPI Number | 1639618101
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Entity Type | Organization
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Legal Business Name | MEGAN K. BUCKLIN, LCPC, P.C.
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Dates
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Enumeration Date | 02/16/2017
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Last Update Date | 02/16/2017
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Provider Practice Location Address
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Address Line | 19 HERITAGE DR SUITE 208
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City | BOURBONNAIS
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State | IL
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Zip | 60914-1369
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Country | US
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Telephone | 815-935-5540
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Fax | 866-507-7385
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Provider Business Mailing Address
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Address Line | 19 HERITAGE DR SUITE 208
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City | BOURBONNAIS
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State | IL
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Zip | 60914-1369
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Country | US
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Telephone | 815-935-5540
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Fax | 866-507-7385
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Authorized Official
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Title or Position | OWNER
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Name | MEGAN BUCKLIN
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Credential | LCPC
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Telephone | 815-935-5540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 060.011928
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License Number State | IL
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