Healthcare Provider Details

I. General information

NPI: 1245304377
Provider Name (Legal Business Name): JODEE SUE BUIS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 BALLARD ST
ALTAMONTE SPRINGS FL
32701-5441
US

IV. Provider business mailing address

2354 RIVERDALE CT
OVIEDO FL
32765-8641
US

V. Phone/Fax

Practice location:
  • Phone: 407-339-7451
  • Fax:
Mailing address:
  • Phone: 407-542-6360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH5342
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: