MEDICARE: NATHAN D BUCKLEY MA, CCC,

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	101Y00000X	Counselor	11253822

General Provider Information

NPI Number	:	1639060932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN D BUCKLEY MA, CCC,

Provider Business Mailing Address
First Line	:	7718 MICHAELIS BLVD
Second Line	:
City	:	GRANDE PRAIRIE
State	:	AB
Zip	:	T8W2H7
Country	:	CA
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8837 67 AVE.
Second Line	:	MICHAELIS BLVD
City	:	GRANDE PRAIRIE
State	:	AB
Zip	:	T8W 2X9
Country	:	CA
Telephone Number	:	780-933-8446
Fax Number	:

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

Provider Enumeration Date	:	07/14/2025
Last Update Date	:	07/14/2025

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Directions to “ NATHAN D BUCKLEY MA, CCC,” Practice Location

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