Provider Demographics
NPI:1316783384
Name:KAILEY BUCK LLC
Entity type:Organization
Organization Name:KAILEY BUCK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH PROFESSIONAL/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAILEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:501-765-0352
Mailing Address - Street 1:4349 W BELL FLOWER DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-5112
Mailing Address - Country:US
Mailing Address - Phone:501-765-0352
Mailing Address - Fax:
Practice Address - Street 1:1680 E JOYCE BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-6214
Practice Address - Country:US
Practice Address - Phone:479-309-0811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty