Provider Demographics
NPI:1174917918
Name:BUCHANAN, THERESA (LPC)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 BUTLER SPAETH RD
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-5132
Mailing Address - Country:US
Mailing Address - Phone:307-696-9968
Mailing Address - Fax:
Practice Address - Street 1:5 LANE LN
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-8630
Practice Address - Country:US
Practice Address - Phone:307-674-6878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC859101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor