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General NPI Number Information
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NPI Number | 1245544162
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Entity Type | Individual
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Provider Name | ERNESTINA S BUCK PHD
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Gender | Female
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Dates
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Enumeration Date | 08/03/2010
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Last Update Date | 01/16/2020
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Provider Practice Location Address
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Address Line | 33 SUBWAY ST
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City | BISBEE
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State | AZ
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Zip | 85603
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Country | US
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Telephone | 520-227-3695
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Fax | 855-568-6439
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Provider Business Mailing Address
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Address Line | PO BOX 4171
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City | BISBEE
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State | AZ
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Zip | 85603-4171
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Country | US
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Telephone | 520-227-3695
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Fax | 855-568-6439
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-1608
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License Number State | AZ
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