Provider Demographics
NPI:1659604296
Name:BUCHANAN, DARRELL EUGENE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:EUGENE
Last Name:BUCHANAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 9711248
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79997-1248
Mailing Address - Country:US
Mailing Address - Phone:915-479-8063
Mailing Address - Fax:915-881-4959
Practice Address - Street 1:6090 SURETY DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2041
Practice Address - Country:US
Practice Address - Phone:915-781-1337
Practice Address - Fax:915-881-4959
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical