Active NPI
Lawrence Graham Buckley Jr., CDP
- Addiction (Substance Use Disorder) Counselor
- Lynnwood, WA
National Provider Identifier
1295197333
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 00004052
- Practice address
- 3810 196TH St SW Ste 11
Lynnwood, WA 98036-5746 - Phone
- (425) 248-4900
- Fax
- (425) 248-4703
- NPI assigned
- Mar 28, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 00004052 | WA | Primary |
Addresses
Primary practice location
3810 196TH St SW Ste 11
Lynnwood, WA 98036-5746
Mailing address
P O Box 12598
Everett, WA 98201
Phone (425) 248-4900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00004052 | WA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1459123200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1459123200000",
"number": "1295197333",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P O BOX 12598",
"city": "EVERETT",
"state": "WA",
"postal_code": "98201",
"telephone_number": "425-248-4900",
"fax_number": "425-248-4703"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3810 196TH ST SW STE 11",
"city": "LYNNWOOD",
"state": "WA",
"postal_code": "980365746",
"telephone_number": "425-248-4900",
"fax_number": "425-248-4703"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUCKLEY",
"first_name": "LAWRENCE",
"middle_name": "GRAHAM",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "CDP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-03-28",
"last_updated": "2016-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WA",
"license": "00004052",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lynnwood, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.