Provider Demographics
NPI:1629368758
Name:BUFORD, AMY MICHELLE
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:BUFORD
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:PO BOX 689
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-0689
Mailing Address - Country:US
Mailing Address - Phone:580-286-3301
Mailing Address - Fax:
Practice Address - Street 1:307 W ELM ST
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-4109
Practice Address - Country:US
Practice Address - Phone:580-924-6692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)