Provider Demographics
NPI:1114956471
Name:BUFFINGTON, SHELLEY KAY (LAC)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:KAY
Last Name:BUFFINGTON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:KAY
Other - Last Name:KLEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:515 E BROADWAY AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4407
Mailing Address - Country:US
Mailing Address - Phone:701-751-0443
Mailing Address - Fax:701-751-1616
Practice Address - Street 1:515 1/2 E BROADWAY AVE STE 106
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4408
Practice Address - Country:US
Practice Address - Phone:701-751-0443
Practice Address - Fax:701-751-1616
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND834-6-1-15101YP2500X
NDKLE-66-4695101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
012198OtherBCBS OF ND