Provider Demographics
NPI:1629115746
Name:BUSS, BARCLAY (MFT, LCPC)
Entity Type:Individual
Prefix:
First Name:BARCLAY
Middle Name:
Last Name:BUSS
Suffix:
Gender:F
Credentials:MFT, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 W IRONWOOD DR STE 2
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2644
Mailing Address - Country:US
Mailing Address - Phone:208-664-1594
Mailing Address - Fax:
Practice Address - Street 1:950 W IRONWOOD DR STE 2
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2644
Practice Address - Country:US
Practice Address - Phone:208-664-1594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35471106H00000X
IDLCPC-4300101YM0800X
IDLMFT-4199106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist