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NPI Code Detail

MEDICARE: KITRINA BUSH LPC

MEDICARE: KITRINA BUSH 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 CounselorLPC012741GA

General Provider Information

NPI Number : 1770059354
Entity Type Code : Individual
Provider Name (Legal Business Name) : KITRINA BUSH LPC
Provider Business Mailing Address
First Line : 200 N LEWIS ST
Second Line :
City : LAGRANGE
State : GA
Zip : 30240-2738
Country : US
Telephone Number : 706-887-5787
Fax Number :
Provider Business Practice Location Address
First Line : 200 N LEWIS ST
Second Line :
City : LAGRANGE
State : GA
Zip : 30240-2738
Country : US
Telephone Number : 706-887-5787
Fax Number : 706-780-5402
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/22/2018
Last Update Date : 02/17/2022

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Directions to “ KITRINA BUSH LPC” Practice Location

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