Healthcare Provider Details

I. General information

NPI: 1467503110
Provider Name (Legal Business Name): MARK ALAN BUSH LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E MARKET ST
WARREN OH
44481-1141
US

IV. Provider business mailing address

3535 DARBYSHIRE DR
CANFIELD OH
44406-9233
US

V. Phone/Fax

Practice location:
  • Phone: 330-399-6451
  • Fax: 330-394-6266
Mailing address:
  • Phone: 330-270-5710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC0005242
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.0005242
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: