MEDICARE: MARY BETH BUSSERT LCPC

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
1	101YM0800X	Mental Health Counselor	180004924	IL

General Provider Information

NPI Number	:	1033607338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY BETH BUSSERT LCPC

Provider Business Mailing Address
First Line	:	2101 WAUKEGAN RD STE 302
Second Line	:
City	:	BANNOCKBURN
State	:	IL
Zip	:	60015-1836
Country	:	US
Telephone Number	:	847-224-6762
Fax Number	:	847-295-1600

Provider Business Practice Location Address
First Line	:	4256 N ARLINGTON HEIGHTS RD STE 101
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-1399
Country	:	US
Telephone Number	:	847-295-1600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2018
Last Update Date	:	12/12/2023

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