Healthcare Provider Details

I. General information

NPI: 1811378649
Provider Name (Legal Business Name): CHRISTIE ELLIS BUSH M.A, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 MATCH FACTORY PL
BELLEFONTE PA
16823-1367
US

IV. Provider business mailing address

190 MATCH FACTORY PL
BELLEFONTE PA
16823-1367
US

V. Phone/Fax

Practice location:
  • Phone: 814-353-3151
  • Fax: 814-355-2244
Mailing address:
  • Phone: 814-353-3151
  • Fax: 814-355-2244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: