Individual
MRS. KIM M BUSTAMANTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC II, QMHA
Contact information
Practice address
3321 HAROLD DRIVE, SALEM, OR 97305
(503) 363-2021
(503) 363-4820
Mailing address
3321 HAROLD DR NE, SALEM, OR 97305-1339
(503) 363-2021
(503) 363-4820
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
OR
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
—
OR
Other
Enumeration date
05/06/2008
Last updated
11/16/2012
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