Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 87000564A | IN |
NPI | 1003091133 |
---|---|
Provider Name | Heather R Buckland |
First Address | Muncie, IN 47304-3988 |
Second Address | Richmond, IN 47374-4101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2008 |
Last Update Date | 05/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
35001632A | LMFT LICENSE (01) | IN |