Provider Demographics
NPI:1366031346
Name:BUSQUE, DOREEN HELEN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:DOREEN
Middle Name:HELEN
Last Name:BUSQUE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 YELLOWTHROAT DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-1365
Mailing Address - Country:US
Mailing Address - Phone:321-298-7873
Mailing Address - Fax:
Practice Address - Street 1:1620 YELLOWTHROAT DR
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-1365
Practice Address - Country:US
Practice Address - Phone:321-298-7873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT129377225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist