Provider Demographics
NPI:1457958464
Name:BUCHANAN, HOLLY KATHLEEN (NCC, LPC)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:KATHLEEN
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 W GRAND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FOX LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60020-1224
Mailing Address - Country:US
Mailing Address - Phone:847-322-2975
Mailing Address - Fax:
Practice Address - Street 1:34 W GRAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:FOX LAKE
Practice Address - State:IL
Practice Address - Zip Code:60020-1224
Practice Address - Country:US
Practice Address - Phone:847-322-2975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health