Individual provider · Type 1 NPI

Jerry Allen Buck Iii

Mental Health Counselor · Portland, OR

NPI number 1043840762 Active

Practice location

12360 E Burnside St
Portland, OR 97233-1042

Call (971) 279-4800 Map

Fax (971) 279-2051

Mailing address

211 SE Caruthers St
Portland, OR 97214-4502

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800X26-QMHA-R-8338 (OR)

Mental Health Counselor: Definition to come...

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About NPI 1043840762

Jerry Allen Buck Iii's National Provider Identifier is 1043840762, issued on Jan 22, 2020. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Portland, OR. The record was last updated on Jul 29, 2026.