Provider Demographics
NPI:1992230692
Name:PUCAR, FRANK JR
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:PUCAR
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 KINGFISH DR
Mailing Address - Street 2:
Mailing Address - City:GRANITE SHOALS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-1538
Mailing Address - Country:US
Mailing Address - Phone:830-637-0279
Mailing Address - Fax:
Practice Address - Street 1:606 AVENUE J
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-5146
Practice Address - Country:US
Practice Address - Phone:830-693-0530
Practice Address - Fax:830-637-7438
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11258101YA0400X
TX81459101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)