Healthcare Provider Details

I. General information

NPI: 1497468821
Provider Name (Legal Business Name): BUZICK COUNSELING SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2022
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 DEMERS AVE
GRAND FORKS ND
58201-4528
US

IV. Provider business mailing address

523 DEMERS AVE
GRAND FORKS ND
58201-4528
US

V. Phone/Fax

Practice location:
  • Phone: 701-354-1387
  • Fax: 701-291-1882
Mailing address:
  • Phone: 701-354-1387
  • Fax: 701-291-1882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: AMBER BUZICK
Title or Position: OWNER
Credential: LCSW
Phone: 701-354-1387