Provider Demographics
NPI:1770699811
Name:BUSBY, CHERYL (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:
Last Name:BUSBY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1589
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72018-1589
Mailing Address - Country:US
Mailing Address - Phone:501-315-3344
Mailing Address - Fax:501-303-3176
Practice Address - Street 1:707 ROBINS ST STE 100
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6516
Practice Address - Country:US
Practice Address - Phone:501-317-1357
Practice Address - Fax:501-327-0970
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-1735101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X192Medicare PIN