Healthcare Provider Details

I. General information

NPI: 1003107145
Provider Name (Legal Business Name): CARRIE P BUSSMANN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2011
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 S ELDORADO RD STE 400
BLOOMINGTON IL
61704-6068
US

IV. Provider business mailing address

808 S ELDORADO RD STE 400
BLOOMINGTON IL
61704-6068
US

V. Phone/Fax

Practice location:
  • Phone: 309-585-0241
  • Fax:
Mailing address:
  • Phone: 309-585-0241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180005335
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: