Provider Demographics
NPI:1790326593
Name:RUTA BUCHANAN, ANNE MARIE ELENA (LPCC686)
Entity Type:Individual
Prefix:MS
First Name:ANNE MARIE
Middle Name:ELENA
Last Name:RUTA BUCHANAN
Suffix:
Gender:F
Credentials:LPCC686
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 S LOWRY ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-5035
Mailing Address - Country:US
Mailing Address - Phone:714-941-2257
Mailing Address - Fax:
Practice Address - Street 1:17772 IRVINE BLVD STE 102-1
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3256
Practice Address - Country:US
Practice Address - Phone:714-941-2257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC686101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional