Individual
RUSSELL BUFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LP
Contact information
Practice address
CORNER OF ROUTE N12 AND N7, FORT DEFIANCE, AZ 86504
(928) 729-8000
Mailing address
PO BOX 649, FORT DEFIANCE, AZ 86504-0649
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
22220
NC
103T00000X
Psychologist
Primary
5098
NC
Other
Enumeration date
01/27/2016
Last updated
11/01/2019
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