Provider Demographics
NPI:1891766358
Name:BUCHANAN, MERRILEE (LCSW)
Entity type:Individual
Prefix:
First Name:MERRILEE
Middle Name:
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 PHEASANT WAY
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-5431
Mailing Address - Country:US
Mailing Address - Phone:435-649-8133
Mailing Address - Fax:435-649-2157
Practice Address - Street 1:1753 SIDEWINDER DR
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7258
Practice Address - Country:US
Practice Address - Phone:435-649-8347
Practice Address - Fax:435-649-2157
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT31467835011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT690947OtherDESERET MUTUAL
UT942938348001OtherCHAMPUS
UT107004105101OtherINTERMOUNTAIN HEALTH CARE
UT107004105101OtherINTERMOUNTAIN HEALTH CARE