| Doctor Name: | MICHELLE BUCKHOLZ |
| NPI Number: | 1215323977 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CDP |
| License Number: | CP60551022 |
| Business Practice Address: | 621 Grade St Kelso, WA - 986262606 |
| Business Phone Number: | 3604259210 |
| Business Fax Number: | |
| Mailing Address: | 1057 12th Ave, LONGVIEW |
| State: | WA |
| Postal Code: | 986322509 |
| Phone Number: | 3604259210 |
| Fax Number: | |
| NPI Enumeration Date: | 04/09/2015 |
| NPI Last Update Date: | 02/08/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | CP60551022 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |