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1770965709 NPI number — RENATA BUSH LPC

NPI Number: 1770965709
Health Care Provider/Practitioner: RENATA BUSH LPC

Information about “1770965709” NPI (RENATA BUSH LPC) exists in 1770965709 in HTML format HTML  |  1770965709 in plain Text format TXT  |  1770965709 in PDF (Portable Document Format) PDF  |  1770965709 in an XML format XML  formats.

NPI Number : 1770965709 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1770965709",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BUSH",
    "FirstName": "RENATA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LPC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MADDOX",
    "OtherFirstName": "RENATA",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MADDOX",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "PO BOX 40401",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "REDFORD",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48240-0401",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "313-401-0990",
    "MailingAddressFaxNumber": "248-327-3565",
    "FirstLinePracticeLocationAddress": "24901 NORTHWESTERN HWY STE 314E",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SOUTHFIELD",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48075-2207",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "313-401-0990",
    "PracticeLocationAddressFaxNumber": "248-327-3565",
    "EnumerationDate": "06/25/2015",
    "LastUpdateDate": "09/12/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "6401012944",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "6401018001",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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