Provider Demographics
NPI:1194182998
Name:BUSH, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17210 CAMPBELL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-4202
Mailing Address - Country:US
Mailing Address - Phone:972-250-1700
Mailing Address - Fax:
Practice Address - Street 1:17210 CAMPBELL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-4202
Practice Address - Country:US
Practice Address - Phone:972-250-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor