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General NPI Number Information
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NPI Number | 1679982961
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Entity Type | Individual
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Provider Name | JENNIFER BUSSELL
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Gender | Female
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Dates
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Enumeration Date | 08/12/2014
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Last Update Date | 09/18/2015
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Provider Practice Location Address
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Address Line | 1733 WOODSTEAD CT
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City | THE WOODLANDS
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State | TX
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Zip | 77380-3401
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Country | US
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Telephone | 760-207-1879
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9036
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City | THE WOODLANDS
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State | TX
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Zip | 77387-9036
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Country | US
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Telephone |
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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 | 12535
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 70831
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License Number State | TX
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