1629045422 NPI number — MICHELLE LOUISE BUHMAN-LIVERMORE LCSW

Table of content: MICHELLE LOUISE BUHMAN-LIVERMORE LCSW (NPI 1629045422)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629045422 NPI number — MICHELLE LOUISE BUHMAN-LIVERMORE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUHMAN-LIVERMORE
Provider First Name:
MICHELLE
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TOLIVER
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629045422
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6332 WEST LAREDO ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHANDLER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-769-4767
Provider Business Mailing Address Fax Number:
712-234-0225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELDON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51201-1242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-324-5356
Provider Business Practice Location Address Fax Number:
712-324-6515
Provider Enumeration Date:
03/01/2006

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: 1041C0700X , with the licence number:  LCSW-12738 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 05630 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: 05630 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 05630 . This is a "LICENSE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: LCSW-12738 . This is a "ARIZONA BOARD OF BEHAVIORAL HEALTH" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".