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General NPI Number Information
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NPI Number | 1649504416
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Entity Type | Individual
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Provider Name | DEANNE JEAN BUSH I
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Gender | Female
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Dates
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Enumeration Date | 09/28/2009
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Last Update Date | 09/28/2009
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Provider Practice Location Address
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Address Line | 54 SENECA ST
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City | PONTIAC
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State | MI
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Zip | 48342-2349
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Country | US
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Telephone | 248-836-0196
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Fax |
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Provider Business Mailing Address
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Address Line | 18777 INNSBROOK DR APT 402
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City | NORTHVILLE
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State | MI
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Zip | 48168-2221
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Country | US
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Telephone | 313-461-9510
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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