Provider Demographics
NPI:1003288333
Name:BUSH, JAMES (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:BUSH
Suffix:
Gender:M
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 BOYD DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-8648
Mailing Address - Country:US
Mailing Address - Phone:615-424-8096
Mailing Address - Fax:
Practice Address - Street 1:805 S CHURCH ST STE 1
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-4916
Practice Address - Country:US
Practice Address - Phone:615-295-2740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3445101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional