MEDICARE: TRACY E BUSSEY LMHC, M.ED, ACS

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	101YM0800X	Mental Health Counselor	006262-1	NY

General Provider Information

NPI Number	:	1528575438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY E BUSSEY LMHC, M.ED, ACS

Provider Business Mailing Address
First Line	:	95 ALLENS CREEK RD STE 324
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618-3246
Country	:	US
Telephone Number	:	585-857-6081
Fax Number	:

Provider Business Practice Location Address
First Line	:	95 ALLENS CREEK RD STE 324
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618-3246
Country	:	US
Telephone Number	:	585-857-6081
Fax Number	:	585-857-6081

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

Provider Enumeration Date	:	01/02/2018
Last Update Date	:	01/02/2018

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