Provider Demographics
NPI:1376762278
Name:BUCHANAN, PAULETTE L (MFTI)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:L
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5777 W CENTURY BLVD
Mailing Address - Street 2:STE 910
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5600
Mailing Address - Country:US
Mailing Address - Phone:310-670-6767
Mailing Address - Fax:310-670-2626
Practice Address - Street 1:5777 W CENTURY BLVD
Practice Address - Street 2:STE 910
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-5600
Practice Address - Country:US
Practice Address - Phone:310-670-6767
Practice Address - Fax:310-670-2626
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF46810106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist