Provider Demographics
NPI:1720397417
Name:BUCK, PAMELA RENA' (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:RENA'
Last Name:BUCK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1854 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:SENATOBIA
Mailing Address - State:MS
Mailing Address - Zip Code:38668-6378
Mailing Address - Country:US
Mailing Address - Phone:662-560-9443
Mailing Address - Fax:
Practice Address - Street 1:408 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SENATOBIA
Practice Address - State:MS
Practice Address - Zip Code:38668-2153
Practice Address - Country:US
Practice Address - Phone:901-827-7303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS36-608103TC0700X
TNP0000002293103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical