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General NPI Number Information
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NPI Number | 1740649490
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Entity Type | Organization
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Legal Business Name | SCOTT D BUSH LLC
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Dates
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Enumeration Date | 02/22/2016
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Last Update Date | 02/22/2016
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Provider Practice Location Address
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Address Line | 21001 REINDEER RD
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City | CHRISTMAS
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State | FL
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Zip | 32709-9122
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Country | US
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Telephone | 407-230-4949
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Fax |
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Provider Business Mailing Address
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Address Line | 21001 REINDEER RD
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City | CHRISTMAS
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State | FL
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Zip | 32709-9122
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNR
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Name | DR. SCOTT D BUSH
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Credential | PHD, LMHC
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Telephone | 407-230-4949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MH10961
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License Number State | FL
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