Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jerry Allen Buck III

Individual provider Mental Health Counselor · NPI 1043840762

Jerry Allen Buck III is a Mental Health Counselor in Portland, Oregon. Licensed in Oregon. Registered with an NPI since 2020.

Licensed in
OR
In the registry since
2020

Practice location Address checks out

12360 E Burnside St
Portland, OR 97233-1042
Phone: (971) 279-4800
Fax: (971) 279-2051
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X · Licence 26-QMHA-R-8338 (OR)

Record details

NPI number1043840762
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJanuary 22, 2020
Last updated in NPPESJuly 29, 2026
Certification dateJuly 29, 2026

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