MEDICARE: KIMBERLY BUSSEN LPC

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	2013044075	MO
2	101YP2500X	Professional Counselor	2013044075	MO

General Provider Information

NPI Number	:	1457763146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY BUSSEN LPC

Provider Business Mailing Address
First Line	:	203 SUMMER GLEN LN
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-3818
Country	:	US
Telephone Number	:	314-602-5245
Fax Number	:

Provider Business Practice Location Address
First Line	:	203 SUMMER GLEN LN
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-3818
Country	:	US
Telephone Number	:	314-602-5245
Fax Number	:

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

Provider Enumeration Date	:	05/29/2014
Last Update Date	:	10/11/2023

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