Healthcare Provider Details

I. General information

NPI: 1972013340
Provider Name (Legal Business Name): BROOKE SIMECKA BUSH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 10/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CHESTERFIELD ST N
AIKEN SC
29801-3934
US

IV. Provider business mailing address

120 CHESTERFIELD ST N
AIKEN SC
29801-3934
US

V. Phone/Fax

Practice location:
  • Phone: 803-641-9979
  • Fax:
Mailing address:
  • Phone: 803-641-9979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6541
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: