Healthcare Provider Details

I. General information

NPI: 1992268890
Provider Name (Legal Business Name): SHELIA BUSH MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 COURT STREET
WEST POINT MS
39773
US

IV. Provider business mailing address

302 N JACKSON ST
STARKVILLE MS
39759-2504
US

V. Phone/Fax

Practice location:
  • Phone: 662-494-7060
  • Fax: 662-494-7533
Mailing address:
  • Phone: 662-323-9318
  • Fax: 662-323-5553

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: