Provider Demographics
NPI:1093833501
Name:BUCHANAN, NICOLE THERESE (PHD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:THERESE
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1353
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48826-1353
Mailing Address - Country:US
Mailing Address - Phone:517-575-7449
Mailing Address - Fax:866-333-5591
Practice Address - Street 1:200 WOODLAND PASS STE E
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-2000
Practice Address - Country:US
Practice Address - Phone:517-575-7449
Practice Address - Fax:866-333-5591
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012177103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical