MEDICARE: PATRICIA BUSHEY MS, MFT INTERN

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	IMF46045	CA

General Provider Information

NPI Number	:	1205038635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA BUSHEY MS, MFT INTERN

Provider Business Mailing Address
First Line	:	1560 HANNAH CT
Second Line	:
City	:	DIXON
State	:	CA
Zip	:	95620-4100
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5777 MADISON AVE
Second Line	:	SUITE 240
City	:	SACRAMENTO
State	:	CA
Zip	:	95841-3315
Country	:	US
Telephone Number	:	916-679-4923
Fax Number	:	916-344-0739

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

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	07/08/2007

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