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General NPI Number Information
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NPI Number | 1427303320
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Entity Type | Individual
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Provider Name | LENNOX TRAVIS BUCHANAN M.S., LMFT, LAADC
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Gender | Male
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Dates
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Enumeration Date | 07/17/2012
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Last Update Date | 11/05/2022
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Provider Practice Location Address
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Address Line | 218 W MAIN ST STE 101
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City | TUSTIN
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State | CA
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Zip | 92780-7709
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Country | US
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Telephone | 714-668-1962
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Fax |
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Provider Business Mailing Address
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Address Line | 218 W MAIN ST STE 101
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City | TUSTIN
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State | CA
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Zip | 92780-7709
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Country | US
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Telephone | 714-668-1962
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LR02830518
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC 78884
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License Number State | CA
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