Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | TX23833 | TX |
NPI | 1003835471 |
---|---|
Provider Name | Dr. King Landiss Buchanan II |
First Address | Lubbock, TX 79424-2605 |
Second Address | Lubbock, TX 79424-2841 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R58622 | (02) | TX |