Healthcare Provider Details

I. General information

NPI: 1467271346
Provider Name (Legal Business Name): JOTINA LASHA BUCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 GUADALUPE ST STE 260
AUSTIN TX
78705-5654
US

IV. Provider business mailing address

4422 STERLING ST
HOUSTON TX
77051-2640
US

V. Phone/Fax

Practice location:
  • Phone: 646-941-7645
  • Fax: 929-596-7897
Mailing address:
  • Phone: 281-923-0306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number87555
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: