Healthcare Provider Details

I. General information

NPI: 1497435762
Provider Name (Legal Business Name): JACLYN R BUSS LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2023
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 E CHURCHVILLE RD STE 300
BEL AIR MD
21014-3485
US

IV. Provider business mailing address

93 BYRON DR
SMITHSBURG MD
21783-1565
US

V. Phone/Fax

Practice location:
  • Phone: 410-893-4600
  • Fax:
Mailing address:
  • Phone: 301-992-7896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC17671
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR199312
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: