Healthcare Provider Details

I. General information

NPI: 1851631238
Provider Name (Legal Business Name): ELIZABETH A BUCK LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 ASPEN DR STE 702B
SANTA FE NM
87505-5480
US

IV. Provider business mailing address

1925 ASPEN DRIVE 702B
SANTA FE NM
87505-6351
US

V. Phone/Fax

Practice location:
  • Phone: 505-930-1828
  • Fax:
Mailing address:
  • Phone: 505-930-1828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0175981
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: