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NPI Code Detail

MEDICARE: TRACY BUSSE LPC

MEDICARE: TRACY BUSSE LPC
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
1101YP2500XProfessional CounselorLPC005221GA

General Provider Information

NPI Number : 1750605275
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY BUSSE LPC
Provider Business Mailing Address
First Line : 3578 S FULTON AVE
Second Line :
City : HAPEVILLE
State : GA
Zip : 30354-1756
Country : US
Telephone Number : 404-768-1156
Fax Number : 404-768-1146
Provider Business Practice Location Address
First Line : 1919 JOHN WESLEY AVE
Second Line :
City : COLLEGE PARK
State : GA
Zip : 30337-3605
Country : US
Telephone Number : 404-762-9190
Fax Number : 404-762-9101
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2010
Last Update Date : 03/26/2010

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Directions to “ TRACY BUSSE LPC” Practice Location

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