NPIMap

Organization Active NPI

Buckelew Programs

  • Community/Behavioral Health Agency
  • Santa Rosa, CA
National Provider Identifier
1497587240
Registry record updated Aug 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
BUCKELEW PROGRAMS
Practice address
2235 Mercury Way Ste 107
Santa Rosa, CA 95407-5472
Phone
(707) 780-7239
NPI assigned
Aug 19, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John Christopher Kughn, LMFT
Title
Ceo
Phone
(415) 457-6966

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

2235 Mercury Way Ste 107
Santa Rosa, CA 95407-5472

Mailing address

2235 Mercury Way Ste 107
Santa Rosa, CA 95407-5472
Phone (707) 780-7239

Other practice location 1

201 Alameda Del Prado
Novato, CA 94949-6688
Phone (415) 457-6964

Other names 1

  • Community Support Services Other name

National Provider Directory

National Provider Directory
Tax ID family
Buckelew Programs13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

201 Alameda del Prado
Novato, CA 94949
Phone (415) 209-8624

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 20

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1724025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724025600000",
    "number": "1497587240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2235 MERCURY WAY STE 107",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954075472",
            "telephone_number": "707-780-7239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2235 MERCURY WAY STE 107",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954075472",
            "telephone_number": "707-780-7239"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "201 Alameda Del Prado",
            "address_purpose": "LOCATION",
            "city": "Novato",
            "state": "CA",
            "postal_code": "949496688",
            "country_code": "US",
            "telephone_number": "415-457-6964",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BUCKELEW PROGRAMS",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-19",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A",
        "authorized_official_last_name": "KUGHN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "415-457-6966",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Support Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.