MEDICARE: MS. MARIA ELAINE BUCCILLI LPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	6401011200	MI

General Provider Information

NPI Number	:	1174822548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIA ELAINE BUCCILLI LPC, NCC

Provider Business Mailing Address
First Line	:	4663 ELM DR
Second Line	:
City	:	WEST BRANCH
State	:	MI
Zip	:	48661-9676
Country	:	US
Telephone Number	:	269-929-7604
Fax Number	:

Provider Business Practice Location Address
First Line	:	4663 ELM DR
Second Line	:
City	:	WEST BRANCH
State	:	MI
Zip	:	48661-9676
Country	:	US
Telephone Number	:	269-929-7604
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2011
Last Update Date	:	09/06/2019

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