MEDICARE: JENNIFER BUFORD LMFTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	35002440A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	35002440A	OTHER	IN	INDIANA PROFESSIONAL LICENSING AGENCY

General Provider Information

NPI Number	:	1538554340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER BUFORD LMFTA

Provider Business Mailing Address
First Line	:	2522 WEBSTER ST
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46807-1348
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2522 WEBSTER ST
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46807-1348
Country	:	US
Telephone Number	:	260-445-7434
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2015
Last Update Date	:	09/26/2024

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