Provider Demographics
NPI:1356857551
Name:BUFFORD, ERIN LYN (LPC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:LYN
Last Name:BUFFORD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:LYN
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:330 1ST CAPITOL DR STE 360
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2859
Mailing Address - Country:US
Mailing Address - Phone:636-947-5578
Mailing Address - Fax:636-947-5599
Practice Address - Street 1:330 1ST CAPITOL DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2835
Practice Address - Country:US
Practice Address - Phone:636-947-5578
Practice Address - Fax:636-947-5599
Is Sole Proprietor?:No
Enumeration Date:2017-12-26
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017034632101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional