Provider Demographics
NPI:1497410591
Name:BUCH, REBECCA (MS)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BUCH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11512 LAKE MEAD AVE UNIT 405
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9687
Mailing Address - Country:US
Mailing Address - Phone:904-385-3113
Mailing Address - Fax:904-374-8950
Practice Address - Street 1:11512 LAKE MEAD AVE UNIT 405
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9687
Practice Address - Country:US
Practice Address - Phone:904-385-3113
Practice Address - Fax:904-374-8950
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH19093101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health