Provider Demographics
NPI:1053198325
Name:BUSSMANN, JACOB WILLIAM (LPC, MA, NCC)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:WILLIAM
Last Name:BUSSMANN
Suffix:
Gender:M
Credentials:LPC, MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 JOHNSON DR STE B
Mailing Address - Street 2:
Mailing Address - City:ROELAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66205-2922
Mailing Address - Country:US
Mailing Address - Phone:785-230-8538
Mailing Address - Fax:
Practice Address - Street 1:5000 JOHNSON DR STE B
Practice Address - Street 2:
Practice Address - City:ROELAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66205-2922
Practice Address - Country:US
Practice Address - Phone:785-230-8538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04353101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional