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General NPI Number Information
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NPI Number | 1184047011
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Entity Type | Individual
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Provider Name | STEVEN CLARK BUSH, MS.ED, NCC, PCC-S, LLC LPCC-S, LICDC-CS
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Gender | Male
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Dates
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Enumeration Date | 01/29/2014
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Last Update Date | 04/11/2015
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Provider Practice Location Address
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Address Line | 5658 CEDARWOOD DR
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City | LEWISBURG
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State | OH
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Zip | 45338-9000
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Country | US
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Telephone | 937-237-5001
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Fax | 937-237-8252
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Provider Business Mailing Address
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Address Line | 404 PINE ST
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City | GREENVILLE
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State | OH
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Zip | 45331-1255
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Country | US
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Telephone | 937-417-8340
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Fax | 937-237-8252
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 975982
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E. 0500534
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License Number State | OH
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