Organization
MARY KAY BUCKLEY, PSYCHOTHERAPIST INC
Active
Organization
MARY KAY BUCKLEY, PSYCHOTHERAPIST INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY KATHLEEN BUCKLEY LCSW (OWNER/PROVIDER)
(559) 250-6715
Entity
Organization
Contact information
Practice address
1357 W SHAW AVE STE 102, FRESNO, CA 93711-3619
(559) 250-6715
(866) 812-5195
Mailing address
1357 W SHAW AVE STE 102, FRESNO, CA 93711-3619
(559) 250-6715
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7246041
—
CA
Enumeration date
05/17/2020
Last updated
03/12/2022
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