| Doctor Name: | CARRIE P BUSSMANN |
| NPI Number: | 1003107145 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCPC |
| License Number: | 180005335 |
| Business Practice Address: | 706 Oglesby Ave Ste 112 Normal, IL - 617614616 |
| Business Phone Number: | 3095850241 |
| Business Fax Number: | |
| Mailing Address: | 706 Oglesby Ave, Ste 112 NORMAL |
| State: | IL |
| Postal Code: | 617614616 |
| Phone Number: | 3095850241 |
| Fax Number: | |
| NPI Enumeration Date: | 04/24/2011 |
| NPI Last Update Date: | 09/15/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 180005335 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |