Provider Demographics
NPI:1699246983
Name:VAN DEN BUSSCHE-DOLL, COURTNEY (LPCC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:VAN DEN BUSSCHE-DOLL
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1547 30TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-5149
Mailing Address - Country:US
Mailing Address - Phone:218-287-4338
Mailing Address - Fax:218-287-5928
Practice Address - Street 1:1041 HAWK ST
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-6958
Practice Address - Country:US
Practice Address - Phone:218-844-6853
Practice Address - Fax:218-844-6854
Is Sole Proprietor?:No
Enumeration Date:2018-12-11
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC02001101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional