Provider Demographics
NPI:1770722571
Name:BUESE, ROGER CHARLES (LPCC-S)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:CHARLES
Last Name:BUESE
Suffix:
Gender:M
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 W RIVER RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY CITY
Mailing Address - State:OH
Mailing Address - Zip Code:44280-9576
Mailing Address - Country:US
Mailing Address - Phone:330-483-4520
Mailing Address - Fax:
Practice Address - Street 1:230 S COURT ST STE 5
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2259
Practice Address - Country:US
Practice Address - Phone:330-723-7977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE075101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE075OtherOHIO STATE COUNSELOR'S LICENSE