Provider Demographics
NPI:1750524377
Name:BUCHANAN, BRYAN R (NCC, LCPC)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:R
Last Name:BUCHANAN
Suffix:
Gender:M
Credentials:NCC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12611 QUARTERHORSE DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4326
Mailing Address - Country:US
Mailing Address - Phone:240-351-3806
Mailing Address - Fax:
Practice Address - Street 1:12611 QUARTERHORSE DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-4326
Practice Address - Country:US
Practice Address - Phone:240-351-3806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health