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General NPI Number Information
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NPI Number | 1649565656
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Entity Type | Individual
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Provider Name | LARA COLLEEN BUCKLEY PSYD
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Gender | Female
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Dates
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Enumeration Date | 06/17/2011
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 1756 S LEWIS RD
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City | CAMARILLO
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State | CA
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Zip | 93012-8520
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Country | US
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Telephone | 805-383-3669
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Fax | 805-383-3692
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Provider Business Mailing Address
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Address Line | 80 N WOOD RD STE 302
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City | CAMARILLO
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State | CA
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Zip | 93010-8312
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Country | US
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Telephone | 805-910-5382
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY33291
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License Number State | CA
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