Christine J Bushy
Individual provider Active NPI Professional Counselor · Devils Lake, ND
NPI 1811228075 · NPPES record last updated Feb 14, 2020
Key facts
- NPI
- 1811228075
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 630-3-15-09-316 (ND)
- Practice address
- 224 4TH St NW Ste 5
Devils Lake, ND 58301-2960 - Phone
- (701) 662-6776
- Fax
- (701) 662-6889
- NPI assigned
- Jan 27, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ND
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240112003735 | ND | Practitioner - Mental Health Counselor | 5799136883 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Village Family Service Center | Mental Health | Current |
Accepting new patients |
| Village Family Service Center | Current |
Accepting new patients |
Locations
1201 25th St SW
Fargo, ND 58103
Phone (701) 451-4855
2701 12th Ave S
Fargo, ND 58103
Phone (701) 451-4865
20 1st St SW
Ste 250
Minot, ND 58701
Phone (701) 852-3328
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 630-3-15-09A | ND | |
| Professional Counselor | 101YP2500X | 630-3-15-09-316 | ND | Yes |
Addresses
Primary practice location
224 4TH St NW Ste 5
Devils Lake, ND 58301-2960
Mailing address
1201 25TH St S
PO Box 9859
Fargo, ND 58103-2311
Phone (701) 451-4900
Other providers in Devils Lake, ND
- Heidi Brown
- Gerianne Brunelle
- Tracy Kay Buckmeier
- Blaine Landon Burdick
- Tara Bushard
- Tonya R Bussell
- Carly Carlson
- Becky L Carow
- Lindsay Carpenter
- Michael Carr
All providers in Devils Lake, ND · Professional Counselor in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 14, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.