Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003571860 |
---|---|
Provider Name | Austyn Elizabeth Buckley |
First Address | Ishpeming, MI 49849-2168 |
Second Address | Marquette, MI 49855-1955 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2021 |
Last Update Date | 05/11/2021 |