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NPI Code Detail

MEDICARE: CORY BUSH CADTP

MEDICARE: CORY BUSH CADTP
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCA

General Provider Information

NPI Number : 1548195043
Entity Type Code : Individual
Provider Name (Legal Business Name) : CORY BUSH CADTP
Provider Business Mailing Address
First Line : 201 BRUSH ST
Second Line :
City : UKIAH
State : CA
Zip : 95482-3424
Country : US
Telephone Number : 707-462-1934
Fax Number :
Provider Business Practice Location Address
First Line : 201 BRUSH ST
Second Line :
City : UKIAH
State : CA
Zip : 95482-3424
Country : US
Telephone Number : 707-462-6290
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2026
Last Update Date : 06/16/2026

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Directions to “ CORY BUSH CADTP” Practice Location

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