Provider Demographics
NPI:1700763281
Name:BUSHMAN, KATHARYNE ALYSSE (MA, NCC)
Entity type:Individual
Prefix:
First Name:KATHARYNE
Middle Name:ALYSSE
Last Name:BUSHMAN
Suffix:
Gender:F
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 WAVERLY ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-2628
Mailing Address - Country:US
Mailing Address - Phone:435-915-6564
Mailing Address - Fax:
Practice Address - Street 1:2825 STOCKYARD RD STE A11
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1544
Practice Address - Country:US
Practice Address - Phone:406-430-3019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT81101101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health