Provider Demographics
NPI:1710486436
Name:BUCH, THERESA MARIE (LCPC)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:BUCH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 LINCOLN AVE # 711
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3695
Mailing Address - Country:US
Mailing Address - Phone:224-307-4728
Mailing Address - Fax:
Practice Address - Street 1:8001 LINCOLN AVE # 711
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3695
Practice Address - Country:US
Practice Address - Phone:224-307-4728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-08
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNAOS907198820OtherBCBS TN