Provider Demographics
NPI:1124695481
Name:BUCHANAN, DAMIAN JARROD
Entity type:Individual
Prefix:
First Name:DAMIAN
Middle Name:JARROD
Last Name:BUCHANAN
Suffix:
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 1:442 E CLAY RD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-9562
Mailing Address - Country:US
Mailing Address - Phone:564-999-7189
Mailing Address - Fax:
Practice Address - Street 1:307 W COTA ST SHELTON WA 98584
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-9858
Practice Address - Country:US
Practice Address - Phone:360-205-8010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health