Provider Demographics
NPI:1356041727
Name:BUFORD, PAUL (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:BUFORD
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 GOBBLER DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-2578
Mailing Address - Country:US
Mailing Address - Phone:636-345-1106
Mailing Address - Fax:636-356-1319
Practice Address - Street 1:8759 VETERANS MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-7538
Practice Address - Country:US
Practice Address - Phone:636-345-1106
Practice Address - Fax:636-356-1319
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014004877101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional