Provider Demographics
NPI:1629045422
Name:BUHMAN-LIVERMORE, MICHELLE LOUISE (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LOUISE
Last Name:BUHMAN-LIVERMORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LOUISE
Other - Last Name:TOLIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:6332 WEST LAREDO ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226
Mailing Address - Country:US
Mailing Address - Phone:602-769-4767
Mailing Address - Fax:712-234-0225
Practice Address - Street 1:800 OAK ST
Practice Address - Street 2:
Practice Address - City:SHELDON
Practice Address - State:IA
Practice Address - Zip Code:51201-1242
Practice Address - Country:US
Practice Address - Phone:712-324-5356
Practice Address - Fax:712-324-6515
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-127381041C0700X
IA056301041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA05630OtherLICENSE
AZLCSW-12738OtherARIZONA BOARD OF BEHAVIORAL HEALTH
IAI21697Medicare PIN