Provider Demographics
NPI:1427303320
Name:BUCHANAN, LENNOX TRAVIS (MS, LMFT, LAADC)
Entity type:Individual
Prefix:
First Name:LENNOX
Middle Name:TRAVIS
Last Name:BUCHANAN
Suffix:
Gender:M
Credentials:MS, LMFT, LAADC
Other - Prefix:
Other - First Name:TRAVIS
Other - Middle Name:
Other - Last Name:BUCHANAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LMFT, LAADC
Mailing Address - Street 1:218 W MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7709
Mailing Address - Country:US
Mailing Address - Phone:714-668-1962
Mailing Address - Fax:
Practice Address - Street 1:218 W MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7709
Practice Address - Country:US
Practice Address - Phone:714-668-1962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2022-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALR02830518101YA0400X
CAMFC 78884106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)