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General NPI Number Information
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NPI Number | 1467722447
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Entity Type | Individual
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Provider Name | MR. EDWARD LOUIS BUCHANAN IV
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Gender | Male
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Dates
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Enumeration Date | 01/06/2012
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Last Update Date | 11/19/2020
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Provider Practice Location Address
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Address Line | 1887 MONTEREY HWY
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City | SAN JOSE
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State | CA
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Zip | 95112
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Country | US
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Telephone | 408-971-9822
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Fax |
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Provider Business Mailing Address
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Address Line | 1918 UNIVERSITY AVE
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City | BERKELEY
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State | CA
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Zip | 94704-3264
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Country | US
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Telephone | 510-649-1930
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 97677
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License Number State | CA
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