Provider Demographics
NPI:1194263814
Name:BUCHANAN GURN, STACEY LYNNE (BA, CAP)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNNE
Last Name:BUCHANAN GURN
Suffix:
Gender:F
Credentials:BA, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 COLLEGE MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-9153
Mailing Address - Country:US
Mailing Address - Phone:307-673-2510
Mailing Address - Fax:307-673-2513
Practice Address - Street 1:360 COLLEGE MEADOWS DR
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-9153
Practice Address - Country:US
Practice Address - Phone:307-673-2510
Practice Address - Fax:307-673-2513
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYCAP 146101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)