Provider Demographics
NPI:1629400437
Name:BUIS, CARMEN NICOLE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:NICOLE
Last Name:BUIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 VANDIVER DR STE 102
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-2322
Mailing Address - Country:US
Mailing Address - Phone:660-707-3349
Mailing Address - Fax:
Practice Address - Street 1:701 VANDIVER DR STE 102
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202
Practice Address - Country:US
Practice Address - Phone:573-882-7422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013027892104100000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker