Provider Demographics
NPI:1831787902
Name:ANGEL BUCHANAN, PH.D. LLC
Entity type:Organization
Organization Name:ANGEL BUCHANAN, PH.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-906-3900
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-0216
Mailing Address - Country:US
Mailing Address - Phone:847-906-3900
Mailing Address - Fax:847-906-3997
Practice Address - Street 1:115 15TH ST
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-3231
Practice Address - Country:US
Practice Address - Phone:847-906-3900
Practice Address - Fax:847-906-3997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty