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General NPI Number Information
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NPI Number | 1043043359
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Entity Type | Individual
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Provider Name | CHARLES RYAN BUSSARD LPC
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Gender | Male
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Dates
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Enumeration Date | 08/22/2024
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Last Update Date | 08/22/2024
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Provider Practice Location Address
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Address Line | 8899 BROOKSIDE AVE STE 102
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City | WEST CHESTER
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State | OH
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Zip | 45069-7112
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Country | US
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Telephone | 513-759-9744
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Fax |
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Provider Business Mailing Address
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Address Line | 6545 MARKET AVE N STE 100
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City | CANTON
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State | OH
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Zip | 44721-2430
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Country | US
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Telephone | 404-313-4079
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C.2406378
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License Number State | OH
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