Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 3445 | TN |
NPI | 1003288333 |
---|---|
Provider Name | James Bush |
First Address | Murfreesboro, TN 37129-8648 |
Second Address | Murfreesboro, TN 37130-4916 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2015 |
Last Update Date | 26/10/2015 |