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General NPI Number Information
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NPI Number | 1336667005
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Entity Type | Individual
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Provider Name | KRISTY LYNN BUSH
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Gender | Female
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Dates
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Enumeration Date | 09/01/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 12061 DORSETT RD
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City | MARYLAND HEIGHTS
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State | MO
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Zip | 63043-2403
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Country | US
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Telephone | 314-805-9369
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Fax |
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Provider Business Mailing Address
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Address Line | 701 VANDIVER DR
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City | COLUMBIA
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State | MO
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Zip | 65202-2094
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Country | US
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Telephone | 573-886-7422
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Fax |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 2017031767
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License Number State | MO
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