Basic Information
| Provider Information | |||||||||
| NPI: | 1689882656 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUCK | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MHPP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16 ROARING RIVER LOOP | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720708124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5015510686 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20400 COLONEL GLENN RD | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722105323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5018215500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.