Provider Demographics
NPI:1689882656
Name:BUCK, TODD EDWARD (MHPP)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:EDWARD
Last Name:BUCK
Suffix:
Gender:M
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ROARING RIVER LOOP
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:AR
Mailing Address - Zip Code:72070-8124
Mailing Address - Country:US
Mailing Address - Phone:501-551-0686
Mailing Address - Fax:
Practice Address - Street 1:20400 COLONEL GLENN RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72210-5323
Practice Address - Country:US
Practice Address - Phone:501-821-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health