Provider Demographics
NPI:1538622352
Name:BUCK, CHRISTOPHER E (LMFT, DMIN)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:E
Last Name:BUCK
Suffix:
Gender:M
Credentials:LMFT, DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 COMMERCIAL ST NE STE 15
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3418
Mailing Address - Country:US
Mailing Address - Phone:503-743-6209
Mailing Address - Fax:
Practice Address - Street 1:147 COMMERCIAL ST NE STE 15
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3418
Practice Address - Country:US
Practice Address - Phone:503-743-6209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500717667Medicaid