Healthcare Provider Details

I. General information

NPI: 1184763229
Provider Name (Legal Business Name): JAMES W BUECHELE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2164 PARIS CV
HERNANDO MS
38632-1609
US

IV. Provider business mailing address

2164 PARIS CV
HERNANDO MS
38632-1609
US

V. Phone/Fax

Practice location:
  • Phone: 901-219-3075
  • Fax: 901-527-1326
Mailing address:
  • Phone: 901-219-3075
  • Fax: 901-527-1326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number30447
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number30447
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number1381
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1381
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: