Provider Demographics
NPI:1558848770
Name:BUSBY, RENEE CAROL (MSW, LMSW)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:CAROL
Last Name:BUSBY
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:CAROL
Other - Last Name:BRASKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LLMSW
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48764-0310
Mailing Address - Country:US
Mailing Address - Phone:989-362-8636
Mailing Address - Fax:
Practice Address - Street 1:1199 HARRIS AVE
Practice Address - Street 2:
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48763-9681
Practice Address - Country:US
Practice Address - Phone:989-362-8636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011011111041C0700X
MI6801106831104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical