Provider Demographics
NPI:1316414071
Name:BUSSEY, CORY RAY (SUDP)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:RAY
Last Name:BUSSEY
Suffix:
Gender:M
Credentials:SUDP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12715 E MISSION AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1027
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11711 E SPRAGUE AVE STE D4
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-6122
Practice Address - Country:US
Practice Address - Phone:095-927-6838
Practice Address - Fax:509-927-6845
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2024-02-22
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)