Provider Demographics
NPI:1659897270
Name:BUCHANAN, RACHAL ADELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:RACHAL
Middle Name:ADELLE
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-1605
Mailing Address - Country:US
Mailing Address - Phone:801-389-5119
Mailing Address - Fax:801-621-6776
Practice Address - Street 1:11639 S 700 E STE 100
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8298
Practice Address - Country:US
Practice Address - Phone:801-621-6642
Practice Address - Fax:801-621-6776
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT264244-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical