Provider Demographics
NPI:1700144862
Name:ROSS, BUSTER (MA, CADC II, LPC-I)
Entity Type:Individual
Prefix:
First Name:BUSTER
Middle Name:
Last Name:ROSS
Suffix:
Gender:M
Credentials:MA, CADC II, LPC-I
Other - Prefix:
Other - First Name:BUSTER
Other - Middle Name:
Other - Last Name:WERENKO-ROSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5932 SE MILWAUKIE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-5258
Mailing Address - Country:US
Mailing Address - Phone:505-490-9481
Mailing Address - Fax:
Practice Address - Street 1:1901 ESTHER ST
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-9529
Practice Address - Country:US
Practice Address - Phone:505-490-9481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12-R-05101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)