Healthcare Provider Details

I. General information

NPI: 1093649840
Provider Name (Legal Business Name): STACEY LEIGH BUFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 CROSSWAY AVE
MURFREESBORO TN
37130-3089
US

IV. Provider business mailing address

509 CROSSWAY AVE
MURFREESBORO TN
37130-3089
US

V. Phone/Fax

Practice location:
  • Phone: 615-896-9160
  • Fax:
Mailing address:
  • Phone: 615-896-9160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8846
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8846
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: