Healthcare Provider Details

I. General information

NPI: 1598290975
Provider Name (Legal Business Name): DR. JOSUE BUZZE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 STATE ST STE 101
SALEM OR
97301-4541
US

IV. Provider business mailing address

2355 STATE ST STE 101
SALEM OR
97301-4541
US

V. Phone/Fax

Practice location:
  • Phone: 503-383-9543
  • Fax:
Mailing address:
  • Phone: 503-383-9543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3566
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: