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General NPI Number Information
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NPI Number | 1972051811
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Entity Type | Organization
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Legal Business Name | BUCHANAN MARRIAGE AND FAMILY THERAPY SERVICES, PC
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Dates
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Enumeration Date | 09/21/2016
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Last Update Date | 08/20/2019
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Provider Practice Location Address
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Address Line | 4609 HIGHWAY 49 S
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City | MARIPOSA
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State | CA
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Zip | 95338-9701
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Country | US
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Telephone | 714-296-6737
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Fax | 714-459-7208
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Provider Business Mailing Address
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Address Line | 2366 HARRIS RD
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City | MARIPOSA
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State | CA
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Zip | 95338-9761
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Country | US
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Telephone | 714-269-6461
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Fax | 714-459-7208
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Authorized Official
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Title or Position | PRESIDENT/DIRECTOR
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Name | NAOMI S. BUCHANAN
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Credential | LMFT
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Telephone | 714-269-6461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 94542
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License Number State | CA
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