Provider Demographics
NPI:1164638060
Name:BUSH, PAULA ANNETTE (MFT)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:ANNETTE
Last Name:BUSH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 BREA BLVD
Mailing Address - Street 2:SUITE 144
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4125
Mailing Address - Country:US
Mailing Address - Phone:714-687-5225
Mailing Address - Fax:714-529-2143
Practice Address - Street 1:1370 BREA BLVD
Practice Address - Street 2:SUITE 144
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4125
Practice Address - Country:US
Practice Address - Phone:714-687-5225
Practice Address - Fax:714-529-2143
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25371106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist