Individual
JERRY ALLEN BUCK III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12360 E BURNSIDE ST, PORTLAND, OR 97233-1042
(971) 279-4800
(971) 279-2051
Mailing address
211 SE CARUTHERS ST, PORTLAND, OR 97214-4502
(971) 217-9008
(971) 260-0355
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
26-QMHA-R-8338
OR
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
01/22/2020
Last updated
07/29/2026
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