Healthcare Provider Details

I. General information

NPI: 1770221053
Provider Name (Legal Business Name): TRACY L BUGGLIN LPCC-S, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 JOHN GLENN HWY
CAMBRIDGE OH
43725-9028
US

IV. Provider business mailing address

2845 BELL ST
ZANESVILLE OH
43701-1720
US

V. Phone/Fax

Practice location:
  • Phone: 740-439-4428
  • Fax: 740-439-3389
Mailing address:
  • Phone: 740-454-9766
  • Fax: 740-588-6452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.0005807
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0002168
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: