Healthcare Provider Details

I. General information

NPI: 1912816018
Provider Name (Legal Business Name): BEVERLY D BUCHANAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11424 GOODRICH RD
BLOOMINGTON MN
55437-3515
US

IV. Provider business mailing address

11424 GOODRICH RD
BLOOMINGTON MN
55437-3515
US

V. Phone/Fax

Practice location:
  • Phone: 775-843-8231
  • Fax:
Mailing address:
  • Phone: 775-843-8231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: BEVERLY BUCHANAN
Title or Position: OWNER
Credential: LMFT, LADC
Phone: 775-843-8231