Provider Demographics
NPI:1174702682
Name:BUSSMAN, JULIE (PHD)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:BUSSMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 211
Mailing Address - Street 2:
Mailing Address - City:MAD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95552-0211
Mailing Address - Country:US
Mailing Address - Phone:707-601-9268
Mailing Address - Fax:
Practice Address - Street 1:321 VAN DUZEN ROAD
Practice Address - Street 2:
Practice Address - City:MAD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95552
Practice Address - Country:US
Practice Address - Phone:707-574-6616
Practice Address - Fax:707-574-6523
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3992103TC0700X
CA22145103TC0700X
MNLP5708103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ125623OtherMEDICARE PROVIDER NUMBER