Healthcare Provider Details

I. General information

NPI: 1629115746
Provider Name (Legal Business Name): BARCLAY BUSS MFT, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 W IRONWOOD DR STE 2
COEUR D ALENE ID
83814-2644
US

IV. Provider business mailing address

950 W IRONWOOD DR STE 2
COEUR D ALENE ID
83814-2644
US

V. Phone/Fax

Practice location:
  • Phone: 208-664-1594
  • Fax:
Mailing address:
  • Phone: 208-664-1594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC-4300
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC35471
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT-4199
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: