Doctor Name: | KIMBERLY BUSSE |
NPI Number: | 1396138517 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.ED., M.A., LPC |
License Number: | 01665 |
Business Practice Address: | 8646 Eagle Creek Cir Suite 203 Savage, MN - 553781570 |
Business Phone Number: | 6122198633 |
Business Fax Number: | |
Mailing Address: | 916 Arabian Dr, JORDAN |
State: | MN |
Postal Code: | 553523406 |
Phone Number: | 6122198633 |
Fax Number: | |
NPI Enumeration Date: | 03/12/2015 |
NPI Last Update Date: | 03/12/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 01665 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |