Provider Demographics
NPI:1902368830
Name:BUGGEE, ROY (LCPC)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:
Last Name:BUGGEE
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:IL
Mailing Address - Zip Code:62691-1571
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:331 S MAIN ST
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:IL
Practice Address - Zip Code:62691-1571
Practice Address - Country:US
Practice Address - Phone:217-452-3057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180011991101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional