Kellie Nakatsu Buckner, LMFT, ED.S.

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

4510 Issued in SC

Practice address

28 Parkway Commons Way
Greer, SC 29650-5213

Phone

(864) 434-0750

Fax

(877) 991-7982

NPI assigned

Dec 6, 2006

Last updated

Feb 4, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Opted out of Medicare

Yes, effective Jan 15, 2024 through Jan 15, 2028

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423008000000",
    "number": "1811056930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 NEWFORT PL",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296075985",
            "telephone_number": "864-434-0750",
            "fax_number": "877-991-7982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 PARKWAY COMMONS WAY",
            "city": "GREER",
            "state": "SC",
            "postal_code": "296505213",
            "telephone_number": "864-434-0750",
            "fax_number": "877-991-7982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCKNER",
        "first_name": "KELLIE",
        "middle_name": "NAKATSU",
        "credential": "LMFT, ED.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-06",
        "last_updated": "2015-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "SC",
            "license": "4510",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tayloria Bryant
• Austin Bryson
• Fred Buchanan Jr., P.T.
• Christina Jackson Buchheit, LMFT
• Carolyn Buck, PSY.D.
• Jake Budd, DC
• Renata Buffalino, DO
• Jonathan David Bulzan, D.O.
• Todd Riddell Bunger
• Luke Leslie Burchard, M.D.

• Marriage & Family Therapist in Greer, SC
• Providers in Greer, SC by specialty
• Marriage & Family Therapist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.