Provider Demographics
NPI:1316277643
Name:BUCHANAN, CORRIE WILLEFORD
Entity type:Individual
Prefix:
First Name:CORRIE
Middle Name:WILLEFORD
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-4117
Mailing Address - Country:US
Mailing Address - Phone:785-628-2871
Mailing Address - Fax:785-628-1438
Practice Address - Street 1:750 S RANGE AVE
Practice Address - Street 2:
Practice Address - City:COLBY
Practice Address - State:KS
Practice Address - Zip Code:67701-2905
Practice Address - Country:US
Practice Address - Phone:785-462-6774
Practice Address - Fax:785-462-3690
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLPC # 2131101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional