Provider Demographics
NPI:1922119015
Name:BUSTER, TERRY A (MS LCPC, LMFT,LPC)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:A
Last Name:BUSTER
Suffix:
Gender:M
Credentials:MS LCPC, LMFT,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 CORNWALL WAY
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:ID
Mailing Address - Zip Code:83619-2544
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1509 N WHITLEY DR
Practice Address - Street 2:SUITE 11
Practice Address - City:FRUITLAND
Practice Address - State:ID
Practice Address - Zip Code:83619-2259
Practice Address - Country:US
Practice Address - Phone:208-452-2162
Practice Address - Fax:208-452-1232
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-3188101YP2500X
ORC-1425101YP2500X
IDLMFT-2631106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist