Provider Demographics
NPI:1053376095
Name:BUCKHAM, RICHARD DWIGHT JR (PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DWIGHT
Last Name:BUCKHAM
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:RICH
Other - Middle Name:
Other - Last Name:BUCKHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1191 NW TAHOE LANE
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383
Mailing Address - Country:US
Mailing Address - Phone:360-698-4860
Mailing Address - Fax:360-698-3849
Practice Address - Street 1:1191 NW TAHOE LANE
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383
Practice Address - Country:US
Practice Address - Phone:360-698-4860
Practice Address - Fax:360-698-3849
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1000103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist