Provider Demographics
NPI:1093280497
Name:BUCHANAN, SHELBY LYNN (BA, MHP, GMHP)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:LYNN
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:BA, MHP, GMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 POPLAR PL S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2827
Mailing Address - Country:US
Mailing Address - Phone:206-362-0560
Mailing Address - Fax:206-362-1470
Practice Address - Street 1:851 POPLAR PL S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2827
Practice Address - Country:US
Practice Address - Phone:206-362-0560
Practice Address - Fax:206-362-1470
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60566864101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health