MEDICARE: DANA BUSKIRK BLAUCH MA

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	101YP2500X	Professional Counselor	0701006596	VA

General Provider Information

NPI Number	:	1275981664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA BUSKIRK BLAUCH MA

Provider Business Mailing Address
First Line	:	8297 HARPINE HWY
Second Line	:
City	:	LINVILLE
State	:	VA
Zip	:	22834-2214
Country	:	US
Telephone Number	:	540-810-3888
Fax Number	:

Provider Business Practice Location Address
First Line	:	8297 HARPINE HWY
Second Line	:
City	:	LINVILLE
State	:	VA
Zip	:	22834-2214
Country	:	US
Telephone Number	:	540-810-3888
Fax Number	:

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

Provider Enumeration Date	:	05/26/2016
Last Update Date	:	05/26/2016

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