MEDICARE: MS. ANITA ANN THOMAS BUA LCPC,LPC

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	178004743	IL
2	101YP2500X	Professional Counselor	3755-125	WI
3	101YM0800X	Mental Health Counselor	180008157	IL

General Provider Information

NPI Number	:	1457499022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANITA ANN THOMAS BUA LCPC,LPC

Provider Business Mailing Address
First Line	:	1639 N ALPINE RD STE 260
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-1481
Country	:	US
Telephone Number	:	815-395-1500
Fax Number	:	833-656-2718

Provider Business Practice Location Address
First Line	:	1639 N ALPINE RD STE 260
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-1481
Country	:	US
Telephone Number	:	815-395-1500
Fax Number	:	833-656-2718

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

Provider Enumeration Date	:	02/03/2007
Last Update Date	:	12/23/2025

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