MEDICARE: MR. KEITH ARNOLD BUSSEY M.S.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	171M00000X	Case Manager/Care Coordinator
4	225400000X	Rehabilitation Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9259	OTHER	CA	BIS NUMBER

General Provider Information

NPI Number	:	1184770760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEITH ARNOLD BUSSEY M.S.

Provider Business Mailing Address
First Line	:	401 GRAND AVE STE 250
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94610-5056
Country	:	US
Telephone Number	:	415-912-7328
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 GRAND AVE STE 250
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94610-5056
Country	:	US
Telephone Number	:	415-912-7328
Fax Number	:

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

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	05/13/2025

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