Provider Demographics
NPI:1952552622
Name:BUOL, MICHAEL LEROY (MS, LMHC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LEROY
Last Name:BUOL
Suffix:
Gender:M
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14715 NE 117TH CIR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-1903
Mailing Address - Country:US
Mailing Address - Phone:360-883-3951
Mailing Address - Fax:360-883-3951
Practice Address - Street 1:14715 NE 117TH CIR
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-1903
Practice Address - Country:US
Practice Address - Phone:360-883-3951
Practice Address - Fax:360-883-3951
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60145868101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH60145868OtherMENTAL HEALTH COUNSELOR LICENSE