Provider Demographics
NPI:1538565890
Name:BUCHANAN, PAMELA SUZANNE (PSYD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:SUZANNE
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 SW MORRISON ST STE 520
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2216
Mailing Address - Country:US
Mailing Address - Phone:503-515-4815
Mailing Address - Fax:503-242-0558
Practice Address - Street 1:1130 SW MORRISON ST STE 520
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2216
Practice Address - Country:US
Practice Address - Phone:503-515-4815
Practice Address - Fax:503-242-0558
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2290103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic