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NPI Code Detail

MEDICARE: MRS. ABIGAIL BUSH MS,NCC,LPC

MEDICARE:  MRS. ABIGAIL  BUSH  MS,NCC,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
1101YP2500XProfessional Counselor81461TX

General Provider Information

NPI Number : 1588267165
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ABIGAIL BUSH MS,NCC,LPC
Provider Business Mailing Address
First Line : 6001 SUMMERSIDE DR STE 202
Second Line :
City : DALLAS
State : TX
Zip : 75252-5336
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6001 SUMMERSIDE DR
Second Line :
City : DALLAS
State : TX
Zip : 75252-5335
Country : US
Telephone Number : 972-985-1100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2020
Last Update Date : 11/17/2020

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