MEDICARE: LOIS J BUSHONG LMFT

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	35001362A	IN

General Provider Information

NPI Number	:	1598825648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOIS J BUSHONG LMFT

Provider Business Mailing Address
First Line	:	5112 ASPEN TALON CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-9510
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	931 E 86TH ST
Second Line	:	SUITE 101
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-1860
Country	:	US
Telephone Number	:	317-523-5517
Fax Number	:

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	08/20/2007

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Directions to “ LOIS J BUSHONG LMFT” Practice Location

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