Provider Demographics
NPI:1972051811
Name:BUCHANAN MARRIAGE AND FAMILY THERAPY SERVICES, PC
Entity Type:Organization
Organization Name:BUCHANAN MARRIAGE AND FAMILY THERAPY SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:S
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:714-269-6461
Mailing Address - Street 1:2366 HARRIS RD
Mailing Address - Street 2:
Mailing Address - City:MARIPOSA
Mailing Address - State:CA
Mailing Address - Zip Code:95338-9761
Mailing Address - Country:US
Mailing Address - Phone:714-269-6461
Mailing Address - Fax:714-459-7208
Practice Address - Street 1:4609 HIGHWAY 49 S
Practice Address - Street 2:
Practice Address - City:MARIPOSA
Practice Address - State:CA
Practice Address - Zip Code:95338-9701
Practice Address - Country:US
Practice Address - Phone:714-296-6737
Practice Address - Fax:714-459-7208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-21
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94542261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)