Provider Demographics
NPI:1194094862
Name:BUCK, BROOKE (MA, LPC)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:BUCK
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19141 STONE OAK PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3367
Mailing Address - Country:US
Mailing Address - Phone:210-391-0030
Mailing Address - Fax:210-497-2104
Practice Address - Street 1:8607 WURZBACH RD
Practice Address - Street 2:SUITE V-104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1303
Practice Address - Country:US
Practice Address - Phone:210-697-3300
Practice Address - Fax:210-424-0106
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-23
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66220390200000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program