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General NPI Number Information
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NPI Number | 1770965709
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Entity Type | Individual
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Provider Name | RENATA BUSH LPC
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Gender | Female
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Dates
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Enumeration Date | 06/25/2015
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Last Update Date | 09/12/2023
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Provider Practice Location Address
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Address Line | 24901 NORTHWESTERN HWY STE 314E
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City | SOUTHFIELD
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State | MI
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Zip | 48075-2207
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Country | US
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Telephone | 313-401-0990
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Fax | 248-327-3565
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Provider Business Mailing Address
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Address Line | PO BOX 40401
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City | REDFORD
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State | MI
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Zip | 48240-0401
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Country | US
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Telephone | 313-401-0990
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Fax | 248-327-3565
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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 | 6401012944
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License Number State | MI
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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 | 6401018001
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License Number State | MI
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