Provider Demographics
NPI:1619647617
Name:BUCHANAN, CAMILLLA CHRISTINA
Entity Type:Individual
Prefix:
First Name:CAMILLLA
Middle Name:CHRISTINA
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14767 BURT DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-1944
Mailing Address - Country:US
Mailing Address - Phone:712-579-1486
Mailing Address - Fax:
Practice Address - Street 1:10840 OLD MILL RD STE 300
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2664
Practice Address - Country:US
Practice Address - Phone:402-915-2649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health