Provider Demographics
NPI:1760516207
Name:BUCKNAM, DAVID BRUCE (LCPC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:BRUCE
Last Name:BUCKNAM
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
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Mailing Address - Street 1:33494 N LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-1782
Mailing Address - Country:US
Mailing Address - Phone:847-543-1369
Mailing Address - Fax:847-577-4306
Practice Address - Street 1:6615 N BIG HOLLOW RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-2450
Practice Address - Country:US
Practice Address - Phone:309-692-6622
Practice Address - Fax:093-692-6952
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL180-001583101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional