Provider Demographics
NPI:1245090711
Name:BUZE, SHANTERE (LAC)
Entity type:Individual
Prefix:
First Name:SHANTERE
Middle Name:
Last Name:BUZE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3875 S DEW DROP LN
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-8031
Mailing Address - Country:US
Mailing Address - Phone:716-491-3647
Mailing Address - Fax:
Practice Address - Street 1:3875 S DEW DROP LN
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-8031
Practice Address - Country:US
Practice Address - Phone:716-491-3647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC15601101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health