MEDICARE: MRS. DAWN E VANBUSKIRK LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	C9300	MS

General Provider Information

NPI Number	:	1487303772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DAWN E VANBUSKIRK LCSW

Provider Business Mailing Address
First Line	:	7205 HUMPHREY RD
Second Line	:
City	:	VANCLEAVE
State	:	MS
Zip	:	39565-7806
Country	:	US
Telephone Number	:	228-233-6762
Fax Number	:

Provider Business Practice Location Address
First Line	:	7205 HUMPHREY RD
Second Line	:
City	:	VANCLEAVE
State	:	MS
Zip	:	39565-7806
Country	:	US
Telephone Number	:	228-233-6762
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2022
Last Update Date	:	07/26/2022

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