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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

JERRY ALLEN BUCK III
NPI 1043840762
Counselor - Mental Health in Portland, OR

Active since January 22, 2020
12360 E BURNSIDE ST, PORTLAND, OR 97233(971) 279-4800(971) 279-2051 Get Directions Write a Review

NPPES record last updated: July 29, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jul 29, 2026, Jan 22, 2020 (2 updates tracked since 2020).

About Jerry Allen Buck Iii NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JERRY ALLEN BUCK III (NPI 1043840762) is an individual mental health provider in Portland, Oregon, licensed in Oregon (26-QMHA-R-8338) and active in the NPI registry since January 2020.

NPPES Registry Identity

NPI1043840762
Entity TypeIndividualMale
Primary Taxonomy101YM0800X
Provider Legal NameJERRY ALLEN BUCK III
Location Address12360 E BURNSIDE STPortland, OR 97233-1042
Mailing Address211 Se Caruthers StPortland, OR 97214-4502 · (971) 217-9008 · Fax (971) 260-0355
Phone(971) 279-4800
Fax(971) 279-2051
Sole ProprietorNo
Enumeration DateJanuary 22, 2020
Last NPPES UpdateJuly 29, 20262 updates tracked since enumeration
NPPES CertifiedJuly 29, 2026
✔ NPI 1043840762 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in OR · 26-QMHA-R-8338
12360 E BURNSIDE ST, Portland, OR 97233
Open in Google Maps ↗

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ANGEL T HIRSCH PCA/QMHP-C
Counselor
12360 E BURNSIDE ST
PORTLAND, OR 97233
Multnomah County (971) 279-4800
CHRISTA R ANDREASEN RN
Registered Nurse
12360 E BURNSIDE ST
PORTLAND, OR 97233
Multnomah County (971) 279-4800
THURSDAY CHARBONEAU PSS
Peer Specialist
12360 E BURNSIDE ST
PORTLAND, OR 97233
Multnomah County (971) 279-4800
NATIVE AMERICAN REHABILITATION ASSOC INC
Clinic/Center (Federally Qualified Health Center (FQHC))
12360 E BURNSIDE ST
PORTLAND, OR 97233
Multnomah County (971) 279-4800
JACQUELINE FAYE RICHLAND CSWA
Social Worker
12360 E BURNSIDE ST
PORTLAND, OR 97233
Multnomah County (971) 279-4800
VALERIE D CHAMBERS RN
Registered Nurse
12360 E BURNSIDE ST
PORTLAND, OR 97233
Multnomah County (971) 279-4800
ELIZABETH MORGAN BRADSHAW LCSW
Social Worker (Clinical)
12360 E BURNSIDE ST
PORTLAND, OR 97233
Multnomah County (971) 278-9480
REBEKAH L TRAVIS QMHA
Counselor (Mental Health)
12360 E BURNSIDE ST
PORTLAND, OR 97233
Multnomah County (971) 279-4800

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jerry Buck's NPI number?

The NPI number for Jerry Buck is 1043840762. It was assigned to this individual provider in the NPPES registry on January 22, 2020.

Where is Jerry Buck located?

Jerry Buck practices at 12360 E Burnside St, Portland, OR 97233. The listed phone number is (971) 279-4800.

What is Jerry Buck's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

When was this NPI record last updated?

The NPPES record for Jerry Buck was last updated on July 29, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.