Provider Demographics
NPI:1487927695
Name:BUCHANAN, KRISTIN PHILLIPS (MSED, BCBA)
Entity type:Individual
Prefix:MISS
First Name:KRISTIN
Middle Name:PHILLIPS
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:MSED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5595 E HINSDALE CIR
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2537
Mailing Address - Country:US
Mailing Address - Phone:303-349-8778
Mailing Address - Fax:
Practice Address - Street 1:9233 PARK MEADOWS DR
Practice Address - Street 2:
Practice Address - City:LONETREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5426
Practice Address - Country:US
Practice Address - Phone:303-349-8778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-10-6921103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst