MEDICARE: DANIELLE BUCHANAN LCSW

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	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker	L6910	OR

General Provider Information

NPI Number	:	1134470560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE BUCHANAN LCSW

Provider Business Mailing Address
First Line	:	2051 KAEN RD
Second Line	:	367
City	:	OREGON CITY
State	:	OR
Zip	:	97045-4035
Country	:	US
Telephone Number	:	503-655-8278
Fax Number	:

Provider Business Practice Location Address
First Line	:	19761 BEAVERCREEK RD
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-9557
Country	:	US
Telephone Number	:	503-785-8770
Fax Number	:

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

Provider Enumeration Date	:	09/25/2012
Last Update Date	:	06/06/2016

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