Provider Demographics
NPI:1376599266
Name:BUSSEY, HAROLD R (MSW)
Entity Type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:R
Last Name:BUSSEY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 E SPRING VALLEY RD
Mailing Address - Street 2:STE B
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-3803
Mailing Address - Country:US
Mailing Address - Phone:937-291-1351
Mailing Address - Fax:937-291-1719
Practice Address - Street 1:180 E SPRING VALLEY RD
Practice Address - Street 2:STE B
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-3803
Practice Address - Country:US
Practice Address - Phone:937-291-1351
Practice Address - Fax:937-291-1719
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00015101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBUSW30401Medicare ID - Type Unspecified