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General NPI Number Information
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NPI Number | 1619195674
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Entity Type | Individual
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Provider Name | COREY DION BUSH PSYCHOLOGIST
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Gender | Male
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 3853 ROSECRANS ST
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City | SAN DIEGO
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State | CA
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Zip | 92110-3115
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Country | US
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Telephone | 619-692-8225
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Fax |
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Provider Business Mailing Address
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Address Line | 17141 W BERNARDO DR 106
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City | SAN DIEGO
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State | CA
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Zip | 92127-1525
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Country | US
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Telephone | 858-613-1275
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.007732
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License Number State | IL
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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 | 16314
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License Number State | AZ
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