Healthcare Provider Details

I. General information

NPI: 1770722571
Provider Name (Legal Business Name): ROGER CHARLES BUESE LPCC-S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 S COURT ST STE 5
MEDINA OH
44256-2259
US

IV. Provider business mailing address

454 W RIVER RD
VALLEY CITY OH
44280-9576
US

V. Phone/Fax

Practice location:
  • Phone: 330-723-7977
  • Fax:
Mailing address:
  • Phone: 330-483-4520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE075
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: