Matthew Reed Buckley, EDD

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MSLPC0624 Issued in MS

Practice address

Highway 8 Ewing 337
Delta State University
Cleveland, MS 38733

Phone

(662) 846-4357

Fax

(662) 846-4549

NPI assigned

May 17, 2007

Sex

Male

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1659588804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1713 DEERING ST",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "387322934",
            "telephone_number": "662-843-1324",
            "fax_number": "662-846-4549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HIGHWAY 8 EWING 337",
            "address_2": "DELTA STATE UNIVERSITY",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "38733",
            "telephone_number": "662-846-4357",
            "fax_number": "662-846-4549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCKLEY",
        "first_name": "MATTHEW",
        "middle_name": "REED",
        "name_prefix": "Dr.",
        "credential": "EDD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MS",
            "license": "MSLPC0624",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brookhaven Medical Center, PLLC
• Amberly Brown
• Celeste Brown
• Hamilton Brown, D.M.D.
• Nate Brown, MD
• Emily McKinion Burroughs, PMHNP
• Jemecia N. Calvin, MS, LPC, NCC
• Ruth Avegail Ragadio Capapas
• Charles W. Capps III, FNP
• Cardiovascular Solutions of Central Ms PA

• All providers in Cleveland, MS
• Mental Health Counselor in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.