1104095983 NPI number — MR. STEPHEN LEE BUSICK MASTER OF ARTS IN CO

Table of content: MR. STEPHEN LEE BUSICK MASTER OF ARTS IN CO (NPI 1104095983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104095983 NPI number — MR. STEPHEN LEE BUSICK MASTER OF ARTS IN CO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUSICK
Provider First Name:
STEPHEN
Provider Middle Name:
LEE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MASTER OF ARTS IN CO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104095983
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
511 W GREEN STREET
Provider Second Line Business Mailing Address:
THE CHRISTIAN COUNSELING CENTER
Provider Business Mailing Address City Name:
URBANA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61801-3942
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-337-1700
Provider Business Mailing Address Fax Number:
217-337-1713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
511 W GREEN STREET
Provider Second Line Business Practice Location Address:
THE CHRISTIAN COUNSELING CENTER
Provider Business Practice Location Address City Name:
URBANA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61801-3942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-337-1700
Provider Business Practice Location Address Fax Number:
217-337-1713
Provider Enumeration Date:
02/26/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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