Organization
SEACHANGE OVERALL WELLNESS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHNNY JASON BUCK DBH, LPC (MEMBER)
(480) 510-8502
Entity
Organization
Contact information
Practice address
14256 S 47TH ST, PHOENIX, AZ 85044-6205
(480) 510-8502
Mailing address
14256 S 47TH ST, PHOENIX, AZ 85044-6205
(480) 510-8502
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LPC-13746
AZ
Other
Enumeration date
08/03/2012
Last updated
08/03/2012
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