Provider Demographics
NPI:1437352374
Name:BUCK, MICHAEL DEAN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DEAN
Last Name:BUCK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1728
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89505-1728
Mailing Address - Country:US
Mailing Address - Phone:775-337-4555
Mailing Address - Fax:775-337-4565
Practice Address - Street 1:350 S CENTER ST
Practice Address - Street 2:SUITE 500
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-2111
Practice Address - Country:US
Practice Address - Phone:775-337-4555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4316-C1041C0700X
AZLCSW-117681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical