Healthcare Provider Details

I. General information

NPI: 1841539426
Provider Name (Legal Business Name): THERESA A. BUZEK LPC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2013
Last Update Date: 02/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4009 BANISTER LN STE 356
AUSTIN TX
78704-7040
US

IV. Provider business mailing address

9364 BERNOULLI DR
AUSTIN TX
78748-5040
US

V. Phone/Fax

Practice location:
  • Phone: 512-468-9959
  • Fax: 512-292-9388
Mailing address:
  • Phone: 512-468-9959
  • Fax: 512-292-9388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number18020
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: