Healthcare Provider Details

I. General information

NPI: 1093627358
Provider Name (Legal Business Name): PAULA BUCK CRM, HCW, CADC-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2665 SW PICKFORD ST APT 5
CORVALLIS OR
97333-1697
US

IV. Provider business mailing address

2665 SW PICKFORD ST APT 5
CORVALLIS OR
97333-1697
US

V. Phone/Fax

Practice location:
  • Phone: 541-286-4010
  • Fax: 541-286-4011
Mailing address:
  • Phone: 541-286-4010
  • Fax: 541-286-4011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-26-6931
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: