Provider Demographics
NPI:1366706145
Name:BUSTAMANTE, MELISSA A (LCPC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:BUSTAMANTE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:LINQUIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:11900 COLLEGE BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-4048
Mailing Address - Country:US
Mailing Address - Phone:913-318-4679
Mailing Address - Fax:
Practice Address - Street 1:11900 COLLEGE BLVD STE 310
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-4048
Practice Address - Country:US
Practice Address - Phone:913-318-4679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLPC 2539101YM0800X
KSLCPC 2511101YM0800X
OHC.1100323101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201080470BMedicaid
OH0268768Medicaid