Healthcare Provider Details

I. General information

NPI: 1932003688
Provider Name (Legal Business Name): EHLANA BUCHANAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 MADISON PROFESSIONAL PARK
REXBURG ID
83440-2057
US

IV. Provider business mailing address

716 LUPINE CIR
REXBURG ID
83440-1700
US

V. Phone/Fax

Practice location:
  • Phone: 208-243-9304
  • Fax:
Mailing address:
  • Phone: 636-748-0442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2581939
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: