Provider Demographics
NPI:1528575438
Name:BUSSEY, TRACY E (LMHC, MED, ACS)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:E
Last Name:BUSSEY
Suffix:
Gender:F
Credentials:LMHC, MED, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 ALLENS CREEK RD STE 324
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3246
Mailing Address - Country:US
Mailing Address - Phone:585-857-6081
Mailing Address - Fax:
Practice Address - Street 1:95 ALLENS CREEK RD STE 324
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3246
Practice Address - Country:US
Practice Address - Phone:585-857-6081
Practice Address - Fax:585-857-6081
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006262-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health