Healthcare Provider Details

I. General information

NPI: 1861691214
Provider Name (Legal Business Name): STEVEN A BUSH MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 01/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13950 MILTON AVE 303
WESTMINSTER CA
92683-2900
US

IV. Provider business mailing address

PO BOX 2489
MISSION VIEJO CA
92690-0489
US

V. Phone/Fax

Practice location:
  • Phone: 714-892-4100
  • Fax:
Mailing address:
  • Phone: 714-892-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: