=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386156438
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAMMY SUE BUSKIRK FEE CDCA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2017
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 196 E EMMITT AVE
-----------------------------------------------------
City | WAVERLY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45690-1334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-912-9499
-----------------------------------------------------
Fax | 740-835-8692
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 33720 STATE ROUTE 683
-----------------------------------------------------
City | MC ARTHUR
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45651-8657
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-703-6290
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | CDCA.162435
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------