Provider Demographics
NPI:1003466731
Name:BUSTOS, JOSUE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOSUE
Middle Name:
Last Name:BUSTOS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 N CENTRAL AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1844
Mailing Address - Country:US
Mailing Address - Phone:602-307-5330
Mailing Address - Fax:602-307-5021
Practice Address - Street 1:1101 N CENTRAL AVE STE 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1844
Practice Address - Country:US
Practice Address - Phone:602-307-5330
Practice Address - Fax:602-307-5021
Is Sole Proprietor?:No
Enumeration Date:2019-09-15
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-179681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical