Healthcare Provider Details

I. General information

NPI: 1932937547
Provider Name (Legal Business Name): JUSTINE BUZALKA CT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24500 CENTER RIDGE RD STE 395
WESTLAKE OH
44145-5631
US

IV. Provider business mailing address

24500 CENTER RIDGE RD STE 395
WESTLAKE OH
44145-5631
US

V. Phone/Fax

Practice location:
  • Phone: 440-455-9125
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2405580-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: