Provider Demographics
NPI:1427689835
Name:BUSSEY, MONTESSA (LPC-INTERN)
Entity type:Individual
Prefix:
First Name:MONTESSA
Middle Name:
Last Name:BUSSEY
Suffix:
Gender:F
Credentials:LPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 HARVEST GLEN DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-6067
Mailing Address - Country:US
Mailing Address - Phone:214-384-0704
Mailing Address - Fax:
Practice Address - Street 1:620 HARVEST GLEN DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-6067
Practice Address - Country:US
Practice Address - Phone:214-384-0704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78296101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional