Healthcare Provider Details

I. General information

NPI: 1407772353
Provider Name (Legal Business Name): MELISSA BUSH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1138 N WESTFIELD ST
WICHITA KS
67212-4013
US

IV. Provider business mailing address

1138 N WESTFIELD ST
WICHITA KS
67212-4013
US

V. Phone/Fax

Practice location:
  • Phone: 316-312-8694
  • Fax:
Mailing address:
  • Phone: 316-312-8694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number04826
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: