Healthcare Provider Details

I. General information

NPI: 1275272825
Provider Name (Legal Business Name): LAUREN BUSH PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11211 PROSPERITY FARMS RD STE C303
PALM BEACH GARDENS FL
33410-3401
US

IV. Provider business mailing address

11211 PROSPERITY FARMS RD STE C303
PALM BEACH GARDENS FL
33410-3401
US

V. Phone/Fax

Practice location:
  • Phone: 561-688-9795
  • Fax: 561-688-9796
Mailing address:
  • Phone: 561-688-9795
  • Fax: 561-688-9796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071010675
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY11757
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: