Buckloh, Lisa M

Buckloh, Lisa M is an individual health care provider with primary practice located at 807 Childrens Way , Jacksonville FL 32207-8426. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical Child & Adolescent, which is considered as her primary health care specialty. Buckloh, Lisa M can be contacted via phone (904) 390-3600.

Contact Information

Primary practice address
807 Childrens Way Jacksonville FL 32207-8426
Phone: (904) 390-3600
Fax: (904) 390-3512
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical Child & Adolescent 103TC2200X PY6027 Florida

Profile Details

NPI number 1811003734
LBN Legal business name Buckloh, Lisa M
Credentials PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 22nd, 2006
Last updated Sep 7th, 2011 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1811003734 NPPES
Georgia MEDICAID 000846942A

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