Provider Demographics
NPI:1417093162
Name:MCCLURE BUFFALO, PATRICIA ANNE (LAC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANNE
Last Name:MCCLURE BUFFALO
Suffix:
Gender:F
Credentials:LAC
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 427
Mailing Address - Street 2:
Mailing Address - City:ST IGNATIUS
Mailing Address - State:MT
Mailing Address - Zip Code:59865
Mailing Address - Country:US
Mailing Address - Phone:406-745-4363
Mailing Address - Fax:406-745-4409
Practice Address - Street 1:35401 MISSION DR
Practice Address - Street 2:
Practice Address - City:SAINT IGNATIUS
Practice Address - State:MT
Practice Address - Zip Code:59865-7791
Practice Address - Country:US
Practice Address - Phone:406-745-4363
Practice Address - Fax:406-745-4409
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-654101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor