Provider Demographics
NPI:1881772721
Name:BUSS, MARY LOU (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARY LOU
Middle Name:
Last Name:BUSS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7910 O ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2500
Mailing Address - Country:US
Mailing Address - Phone:402-489-5339
Mailing Address - Fax:402-489-7366
Practice Address - Street 1:7441 O ST
Practice Address - Street 2:SUITE 304
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2468
Practice Address - Country:US
Practice Address - Phone:402-484-5600
Practice Address - Fax:402-484-5630
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1375101YM0800X
NE4721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEQ23707Medicare UPIN
NE278087Medicare ID - Type UnspecifiedIND PERFORMING PROVIDER #