Healthcare Provider Details

I. General information

NPI: 1619487915
Provider Name (Legal Business Name): DANIEL BUSH MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2017
Last Update Date: 10/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133D MAIN STREET SUITE #4
EPPING NH
03042-2457
US

IV. Provider business mailing address

11 HARVEY LN
EPPING NH
03042-1705
US

V. Phone/Fax

Practice location:
  • Phone: 603-496-6070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1979
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: