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General NPI Number Information
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NPI Number | 1467503110
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Entity Type | Individual
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Provider Name | MARK ALAN BUSH LPC
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Gender | Male
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 150 E MARKET ST
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City | WARREN
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State | OH
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Zip | 44481-1141
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Country | US
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Telephone | 330-399-6451
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Fax | 330-394-6266
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Provider Business Mailing Address
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Address Line | 3535 DARBYSHIRE DR
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City | CANFIELD
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State | OH
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Zip | 44406-9233
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Country | US
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Telephone | 330-270-5710
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C0005242
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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 | C.0005242
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License Number State | OH
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