Healthcare Provider Details

I. General information

NPI: 1831805985
Provider Name (Legal Business Name): SIERRA BUSH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 MOSS HILL TERRACE RD
NATCHITOCHES LA
71457-6426
US

IV. Provider business mailing address

147 MOSS HILL TERRACE RD
NATCHITOCHES LA
71457-6426
US

V. Phone/Fax

Practice location:
  • Phone: 225-993-3021
  • Fax:
Mailing address:
  • Phone: 225-993-3021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11736
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number120007
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW1140152
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: