Provider Demographics
NPI:1154607752
Name:BUCHANAN, KRISTY DAWN (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:DAWN
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2912 W DAVIS ST
Mailing Address - Street 2:SUITE 322
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2041
Mailing Address - Country:US
Mailing Address - Phone:281-685-0321
Mailing Address - Fax:
Practice Address - Street 1:2912 W DAVIS ST
Practice Address - Street 2:SUITE 322
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2041
Practice Address - Country:US
Practice Address - Phone:281-685-0321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64377101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional