1427573013 NPI number — DR. AMY LEE BUCHANAN PSYCHOLOGIST

Table of content: DR. AMY LEE BUCHANAN PSYCHOLOGIST (NPI 1427573013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427573013 NPI number — DR. AMY LEE BUCHANAN PSYCHOLOGIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUCHANAN
Provider First Name:
AMY
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYCHOLOGIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427573013
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
635 SW GOLDEN HILLS DR APT II203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PULLMAN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99163-5864
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-988-4216
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
COUNSELING AND PSYCHOLOGICAL SERVICES, WASHINGTON BLD.
Provider Second Line Business Practice Location Address:
ROOM 302, PO BOX 642333
Provider Business Practice Location Address City Name:
PULLMAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99164-2333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-335-4511
Provider Business Practice Location Address Fax Number:
509-335-2924
Provider Enumeration Date:
08/04/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PY60729714 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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