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General NPI Number Information
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NPI Number | 1396138517
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Entity Type | Individual
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Provider Name | KIMBERLY BUSSE M.ED., M.A., LPCC
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Gender | Female
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Dates
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Enumeration Date | 03/12/2015
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Last Update Date | 04/15/2022
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Provider Practice Location Address
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Address Line | 6001 EGAN DR STE 170
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City | SAVAGE
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State | MN
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Zip | 55378-4919
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Country | US
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Telephone | 612-219-8633
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Fax | 612-930-0111
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Provider Business Mailing Address
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Address Line | 916 ARABIAN DR
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City | JORDAN
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State | MN
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Zip | 55352-3406
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Country | US
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Telephone | 612-219-8633
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 01665
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 001314
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License Number State | MN
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