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General NPI Number Information
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NPI Number | 1588313415
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Entity Type | Organization
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Legal Business Name | JACI BUCKMASTER COUNSELING
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Dates
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Enumeration Date | 03/18/2022
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 916 W 10TH ST STE 205
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City | MEDFORD
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State | OR
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Zip | 97501-3018
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Country | US
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Telephone | 541-500-8655
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Fax | 800-433-1396
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Provider Business Mailing Address
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Address Line | PO BOX 1787
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City | MEDFORD
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State | OR
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Zip | 97501-0261
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Country | US
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Telephone | 541-500-8655
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Fax | 800-433-1396
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Authorized Official
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Title or Position | OWNER
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Name | JACI BUCKMASTER
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Credential | LPC
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Telephone | 541-776-7601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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