Provider Demographics
NPI:1396736849
Name:BUSCHE-GOODSON, DANA L (MAT, LPC)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:L
Last Name:BUSCHE-GOODSON
Suffix:
Gender:F
Credentials:MAT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 W LEXINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-0417
Mailing Address - Country:US
Mailing Address - Phone:573-424-9469
Mailing Address - Fax:573-446-9309
Practice Address - Street 1:1501 W LEXINGTON CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-0417
Practice Address - Country:US
Practice Address - Phone:573-424-9469
Practice Address - Fax:573-446-9309
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003026475101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health