Kelly Marie Buckley, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

2017034803 Issued in MO

Practice address

5106 Hampton Ave Ste 204
Saint Louis, MO 63109-3115

Phone

(636) 208-0114

NPI assigned

Jun 15, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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.

{
    "created_epoch": "1592179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755043200000",
    "number": "1720603830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5106 HAMPTON AVE STE 204",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631093115",
            "telephone_number": "636-208-0114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5106 HAMPTON AVE STE 204",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631093115",
            "telephone_number": "636-208-0114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCKLEY",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-15",
        "last_updated": "2025-08-13",
        "certification_date": "2025-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MO",
            "license": "2017034803",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "2017034803",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fred R Buckhold III, M.D.
• Kathryn A Bucklen, MD
• Arianna Cloe Buckley, MD
• Brenda Lynn Buckley, M.D.
• Catherine Buckley
• Vanja Petroman Buckley, MSW
• Sara Anne Buckman, MD
• Jeanette Rochelle Buckner, REGISTERED NURSE
• Nathan P Buckner, LPC
• Diana K Buckwalter, CNP CNM

• Professional Counselor in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Professional Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2025; 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.