Provider Demographics
NPI:1528368966
Name:WENDY K. BUCHANAN, LMT, LISW
Entity Type:Organization
Organization Name:WENDY K. BUCHANAN, LMT, LISW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:505-860-6766
Mailing Address - Street 1:3503 N BUENA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-2311
Mailing Address - Country:US
Mailing Address - Phone:505-860-6766
Mailing Address - Fax:
Practice Address - Street 1:3300 N BUTLER AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5621
Practice Address - Country:US
Practice Address - Phone:505-860-6766
Practice Address - Fax:505-324-0895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-063861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty