Provider Demographics
NPI:1588419782
Name:BUSSLE, JEANNITA NICOLE (EDD, LPC ASSOCIATE)
Entity type:Individual
Prefix:
First Name:JEANNITA
Middle Name:NICOLE
Last Name:BUSSLE
Suffix:
Gender:F
Credentials:EDD, LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 ENGLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-6721
Mailing Address - Country:US
Mailing Address - Phone:469-798-3434
Mailing Address - Fax:
Practice Address - Street 1:3211 ENGLAND PKWY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75054-6721
Practice Address - Country:US
Practice Address - Phone:469-798-3434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93644101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional