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General NPI Number Information
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NPI Number | 1467271346
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Entity Type | Individual
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Provider Name | JOTINA LASHA BUCK
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Gender | Female
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Dates
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Enumeration Date | 10/07/2024
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 2021 GUADALUPE ST STE 260
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City | AUSTIN
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State | TX
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Zip | 78705-5654
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Country | US
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Telephone | 646-941-7645
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Fax | 929-596-7897
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Provider Business Mailing Address
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Address Line | 4422 STERLING ST
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City | HOUSTON
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State | TX
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Zip | 77051-2640
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Country | US
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Telephone | 281-923-0306
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 87555
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License Number State | TX
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