Healthcare Provider Details

I. General information

NPI: 1205101185
Provider Name (Legal Business Name): JOHN BUSE MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2012
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6535 WILSHIRE BLVD SUITE 259
LOS ANGELES CA
90048-4905
US

IV. Provider business mailing address

6535 WILSHIRE BLVD SUITE 259
LOS ANGELES CA
90048-4905
US

V. Phone/Fax

Practice location:
  • Phone: 323-687-1923
  • Fax:
Mailing address:
  • Phone: 323-687-1923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMFC 51115
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: