Provider Demographics
NPI:1770619041
Name:BUFFORD, MELISSA PHILANA
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:PHILANA
Last Name:BUFFORD
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:INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENT INC
Mailing Address - Street 2:994 S HARRISON RD
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85748
Mailing Address - Country:US
Mailing Address - Phone:520-323-4605
Mailing Address - Fax:
Practice Address - Street 1:5001 E 23RD ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711
Practice Address - Country:US
Practice Address - Phone:520-323-4605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11930385HR2055X, 171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child