Provider Demographics
NPI:1538848841
Name:BUCHANAN, CALLIE MICHELLE (LMFT)
Entity type:Individual
Prefix:MS
First Name:CALLIE
Middle Name:MICHELLE
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 NW 61ST BLVD
Mailing Address - Street 2:
Mailing Address - City:JENNINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32053-2518
Mailing Address - Country:US
Mailing Address - Phone:229-560-0609
Mailing Address - Fax:
Practice Address - Street 1:1813 CECIL WEBB PL
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32060-9223
Practice Address - Country:US
Practice Address - Phone:386-842-5501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT4696101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health