MEDICARE: JACQUELINE BUSH LMFT, BC-TMH

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	106H00000X	Marriage & Family Therapist	2118	NC
2	106H00000X	Marriage & Family Therapist	MFT002250	GA
3	106H00000X	Marriage & Family Therapist	0717002128	VA
4	106H00000X	Marriage & Family Therapist	LCM1108	MD
5	106H00000X	Marriage & Family Therapist	TPMF251	FL
6	106H00000X	Marriage & Family Therapist	MFT1586	LA
7	106H00000X	Marriage & Family Therapist	LMFT200001420	DC
8	106H00000X	Marriage & Family Therapist	206218	TX
9	106H00000X	Marriage & Family Therapist	7054	SC
10	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1073012647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE BUSH LMFT, BC-TMH

Provider Business Mailing Address
First Line	:	PO BOX 82406
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70884-2406
Country	:	US
Telephone Number	:	704-879-1179
Fax Number	:	704-490-4274

Provider Business Practice Location Address
First Line	:	227 W 4TH ST STE 321
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28202-1545
Country	:	US
Telephone Number	:	704-879-1179
Fax Number	:	704-490-4274

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

Provider Enumeration Date	:	02/08/2018
Last Update Date	:	03/04/2026

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