Provider Demographics
NPI:1740068121
Name:ARBUCKLE, JACK RILEY (MS, LPC-A)
Entity type:Individual
Prefix:MR
First Name:JACK
Middle Name:RILEY
Last Name:ARBUCKLE
Suffix:
Gender:M
Credentials:MS, LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 LEBANON RD APT 1324
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-8281
Mailing Address - Country:US
Mailing Address - Phone:214-504-8759
Mailing Address - Fax:
Practice Address - Street 1:825 WATTERS CREEK BLVD BLDG M
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3770
Practice Address - Country:US
Practice Address - Phone:214-556-0996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX92817101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty