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NPI Code Detail

MEDICARE: DR. CHANTAL BUSHELLE

MEDICARE: DR. CHANTAL BUSHELLE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologistPSY.0006109CO

General Provider Information

NPI Number : 1023415502
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHANTAL BUSHELLE
Provider Business Mailing Address
First Line : 2420 HOLLY RIDGE CT
Second Line :
City : CLERMONT
State : FL
Zip : 34711-7713
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1155 KELLY JOHNSON BLVD STE 111
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80920-3957
Country : US
Telephone Number : 917-443-5064
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/26/2014
Last Update Date : 01/01/2024

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Directions to “ DR. CHANTAL BUSHELLE ” Practice Location

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