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General NPI Number Information
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NPI Number | 1174874887
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Entity Type | Individual
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Provider Name | MS. BEVERLY ANN BUSH
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Gender | Female
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Dates
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Enumeration Date | 09/21/2012
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Last Update Date | 07/17/2014
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Provider Practice Location Address
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Address Line | 3634 ELIZABETH ST
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City | RIVERSIDE
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State | CA
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Zip | 92506-2506
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Country | US
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Telephone | 951-341-8930
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Fax | 951-341-8932
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Provider Business Mailing Address
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Address Line | 231 E ALESSANDRO BLVD
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City | RIVERSIDE
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State | CA
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Zip | 92508-5084
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Country | US
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Telephone | 951-341-8930
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Fax | 951-341-8932
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Authorized Official
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Title or Position |
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Name |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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