Provider Demographics
NPI:1437477536
Name:BUCK, KIMBERLY SUE (MA LAC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SUE
Last Name:BUCK
Suffix:
Gender:F
Credentials:MA LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6402 E SUPERSTITION SPRINGS BLVD
Mailing Address - Street 2:208
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4392
Mailing Address - Country:US
Mailing Address - Phone:480-668-8301
Mailing Address - Fax:480-558-3020
Practice Address - Street 1:6402 E SUPERSTITION SPRINGS BLVD
Practice Address - Street 2:208
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4392
Practice Address - Country:US
Practice Address - Phone:480-668-8301
Practice Address - Fax:480-558-3020
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12627101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor