Provider Demographics
NPI:1487706479
Name:BUYNACK, MICHELLE LYNN (MA, NCC)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LYNN
Last Name:BUYNACK
Suffix:
Gender:F
Credentials:MA, NCC
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:BARKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 RANCH RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15909-1150
Mailing Address - Country:US
Mailing Address - Phone:814-242-0221
Mailing Address - Fax:
Practice Address - Street 1:2714 WILLIAM PENN AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15909-1010
Practice Address - Country:US
Practice Address - Phone:814-242-0221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
PAPC004616101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1983399OtherHIGHMARK
PA251601146008OtherTRICARE