MEDICARE: DEBRA MOORE BUSHONG LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	59919	TX

General Provider Information

NPI Number	:	1063624690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA MOORE BUSHONG LPC

Provider Business Mailing Address
First Line	:	PO BOX 845347
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-5347
Country	:	US
Telephone Number	:	214-645-0624
Fax Number	:	214-645-0078

Provider Business Practice Location Address
First Line	:	6363 FOREST PARK RD.
Second Line	:	7TH FLOOR, SUITE 749
City	:	DALLAS
State	:	TX
Zip	:	75390
Country	:	US
Telephone Number	:	214-645-8500
Fax Number	:	214-645-3775

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	06/05/2019

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