Provider Demographics
NPI:1215605001
Name:BUSHER-BETANCOURT, EMILY JEANNE (LSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JEANNE
Last Name:BUSHER-BETANCOURT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 GEORGETOWN AVE APT M23
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-3866
Mailing Address - Country:US
Mailing Address - Phone:440-787-3156
Mailing Address - Fax:
Practice Address - Street 1:401 BROADWAY STE C
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-1749
Practice Address - Country:US
Practice Address - Phone:216-378-9101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-06
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2106495101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health