Provider Demographics
NPI:1790214161
Name:ELIZABETH A. BUCK
Entity Type:Organization
Organization Name:ELIZABETH A. BUCK
Other - Org Name:JOURNEY GUIDANCE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUCK
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-930-1828
Mailing Address - Street 1:2828 VEREDA DE PUEBLO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-5386
Mailing Address - Country:US
Mailing Address - Phone:505-930-1828
Mailing Address - Fax:
Practice Address - Street 1:1925 ASPEN DR STE 702B
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5480
Practice Address - Country:US
Practice Address - Phone:505-930-1828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0175981101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty