Provider Demographics
NPI:1588407449
Name:BUONO, LORI LOUISE ANDERSON (CCCCL61522106)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:LOUISE ANDERSON
Last Name:BUONO
Suffix:
Gender:F
Credentials:CCCCL61522106
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 15TH AVE E APT 101
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4545
Mailing Address - Country:US
Mailing Address - Phone:206-992-3403
Mailing Address - Fax:
Practice Address - Street 1:436 MCPHEE RD SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5014
Practice Address - Country:US
Practice Address - Phone:360-799-5782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACCC.CL.61522106101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health