Provider Demographics
NPI:1871889493
Name:BUSSEY, MICHELLE (MFTI, MA, MA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BUSSEY
Suffix:
Gender:F
Credentials:MFTI, MA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 N N ST
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-4228
Mailing Address - Country:US
Mailing Address - Phone:559-901-8037
Mailing Address - Fax:
Practice Address - Street 1:209 N N ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-4228
Practice Address - Country:US
Practice Address - Phone:559-901-8037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70683106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA70683OtherBOARD OF BEHAVIORAL SERVICES