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General NPI Number Information
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NPI Number | 1386130201
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Entity Type | Individual
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Provider Name | JAN BUSSELL
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Gender | Female
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Dates
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Enumeration Date | 07/03/2018
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Last Update Date | 07/03/2018
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Provider Practice Location Address
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Address Line | 1204 HARPER DR
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City | MARSHALL
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State | TX
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Zip | 75672-5712
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Country | US
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Telephone | 512-497-6541
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Fax |
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Provider Business Mailing Address
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Address Line | 670 SPUR 156
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City | WASKOM
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State | TX
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Zip | 75692-9129
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Country | US
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Telephone | 903-687-2586
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 13341
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License Number State | TX
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