MEDICARE: MR. JUDSON CHRISTOPHER BUCKWALTER MA, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	PC004702	PA

General Provider Information

NPI Number	:	1558539692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JUDSON CHRISTOPHER BUCKWALTER MA, LPC

Provider Business Mailing Address
First Line	:	20 N BARBARA ST STE A
Second Line	:
City	:	MOUNT JOY
State	:	PA
Zip	:	17552-1402
Country	:	US
Telephone Number	:	717-653-1507
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 N BARBARA ST STE A
Second Line	:
City	:	MOUNT JOY
State	:	PA
Zip	:	17552-1402
Country	:	US
Telephone Number	:	717-653-1507
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2008
Last Update Date	:	02/12/2008

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