Provider Demographics
NPI:1932747789
Name:BUCKLES, ZACHARY GIBSON (PSYD)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:GIBSON
Last Name:BUCKLES
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7340 SW HUNZIKER RD STE 210
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-2304
Mailing Address - Country:US
Mailing Address - Phone:503-352-0036
Mailing Address - Fax:
Practice Address - Street 1:7340 SW HUNZIKER RD STE 210
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-2304
Practice Address - Country:US
Practice Address - Phone:503-352-0036
Practice Address - Fax:503-352-0040
Is Sole Proprietor?:No
Enumeration Date:2019-12-11
Last Update Date:2025-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3772103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist