Provider Demographics
NPI:1427495985
Name:BUCHANAN, BEVERLY DENISE (MA, LMFT, LADC)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:DENISE
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:MA, LMFT, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11280 86TH AVE N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4510
Mailing Address - Country:US
Mailing Address - Phone:763-600-6281
Mailing Address - Fax:763-400-7444
Practice Address - Street 1:11280 86TH AVE N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4510
Practice Address - Country:US
Practice Address - Phone:763-600-6281
Practice Address - Fax:763-400-7444
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304551101YA0400X
NV1074I101YA0400X
NVMI0307106H00000X
MN3332106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)