Provider Demographics
NPI:1841211281
Name:BUCHANAN, SHERRY L (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:L
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 S RANGE LINE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-3248
Mailing Address - Country:US
Mailing Address - Phone:417-529-4636
Mailing Address - Fax:417-627-9968
Practice Address - Street 1:2431 S RANGE LINE RD
Practice Address - Street 2:SUITE A
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3248
Practice Address - Country:US
Practice Address - Phone:417-529-4636
Practice Address - Fax:417-627-9968
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY00690103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist