=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932489127
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA SUZANNE BUZEK LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2011
-----------------------------------------------------
Last Update Date | 08/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 323 N 29TH ST
-----------------------------------------------------
City | WACO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76710-7416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-714-2274
-----------------------------------------------------
Fax | 254-714-2166
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9000 CHAPEL RD 3203
-----------------------------------------------------
City | WACO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76712-8740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-571-6102
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 64817
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------