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General NPI Number Information
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NPI Number | 1073020616
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Entity Type | Organization
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Legal Business Name | BUCHANAN COUNSELING SERVICES
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Dates
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Enumeration Date | 01/04/2018
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 5053 LA MART DR STE 207
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City | RIVERSIDE
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State | CA
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Zip | 92507-5990
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Country | US
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Telephone | 951-344-6428
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 52015
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City | RIVERSIDE
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State | CA
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Zip | 92517-3015
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LMFT
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Name | MRS. ILESE BUCHANAN
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Credential | MS
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Telephone | 951-344-6428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 103846
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License Number State | CA
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