Provider Demographics
NPI:1164997011
Name:BUSH, ERICA SUSAN (MSW, LMHP)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:SUSAN
Last Name:BUSH
Suffix:
Gender:F
Credentials:MSW, LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4669 POPPLETON AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-2045
Mailing Address - Country:US
Mailing Address - Phone:402-457-5905
Mailing Address - Fax:
Practice Address - Street 1:4669 POPPLETON AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-2045
Practice Address - Country:US
Practice Address - Phone:402-457-5905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-08
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE57311041S0200X
NE20801041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10942OtherLICENSE NUMBERS
NE7079OtherLICENSE NUMBERS