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General NPI Number Information
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NPI Number | 1831787902
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Entity Type | Organization
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Legal Business Name | ANGEL BUCHANAN, PH.D. LLC
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Dates
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Enumeration Date | 01/05/2021
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Last Update Date | 01/05/2021
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Provider Practice Location Address
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Address Line | 115 15TH ST
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City | WILMETTE
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State | IL
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Zip | 60091-3231
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Country | US
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Telephone | 847-906-3900
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Fax | 847-906-3997
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Provider Business Mailing Address
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Address Line | PO BOX 216
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City | WILMETTE
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State | IL
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Zip | 60091-0216
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Country | US
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Telephone | 847-906-3900
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Fax | 847-906-3997
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | ANGEL BUCHANAN
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Credential | PH.D.
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Telephone | 847-906-3900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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