Healthcare Provider Details

I. General information

NPI: 1932489127
Provider Name (Legal Business Name): REBECCA SUZANNE BUZEK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 08/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 N 29TH ST
WACO TX
76710-7416
US

IV. Provider business mailing address

9000 CHAPEL RD 3203
WACO TX
76712-8740
US

V. Phone/Fax

Practice location:
  • Phone: 254-714-2274
  • Fax: 254-714-2166
Mailing address:
  • Phone: 361-571-6102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number64817
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: