Provider Demographics
NPI:1013668227
Name:BUSS, TERESA R (LPC ATR)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:R
Last Name:BUSS
Suffix:
Gender:F
Credentials:LPC ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3702 N RICHARDS ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1630
Mailing Address - Country:US
Mailing Address - Phone:414-712-3854
Mailing Address - Fax:
Practice Address - Street 1:3702 N RICHARDS ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-1630
Practice Address - Country:US
Practice Address - Phone:414-712-3854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7754-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional