Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kelly A Bushur, CPPHD

Individual provider Clinical Psychologist · NPI 1629248406

Kelly A Bushur, CPPHD is a Clinical Psychologist in Carbondale, Illinois. Qualified in 1996, 30 years ago. Practices with St Louis Behavioral Medicine Institute Inc, a 70-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Illinois.

Years since qualifying
30
Licensed in
IL
In the registry since
2008
Claim this listing Report a problem Suggest an edit

Practice location Address checks out

400 S Lewis Ln
Carbondale, IL 62901-3547
Phone: (618) 519-9900
Fax: (618) 529-1384
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Psychologist (primary) Taxonomy 103TC0700X · Licence 071005772 (IL)

Record details

NPI number1629248406
Entity typeIndividual (Type 1)
GenderFemale
Credentials CPPHD
Sole proprietorNo
NPI enumeratedMarch 7, 2008
Last updated in NPPESOctober 23, 2014
Mailing addressPo Box 577, Carterville, IL 62918-0577

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL PSYCHOLOGIST
Medical schoolOTHER
Graduated 1996 (30 years in practice)
Group practice St. Louis Behavioral Medicine Institute Inc — 70 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Carbondale