Provider Demographics
NPI:1225279185
Name:BUSH, BEVERLY (LMSW)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:BUSH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 VICEROY DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-2208
Mailing Address - Country:US
Mailing Address - Phone:214-358-2300
Mailing Address - Fax:214-366-6088
Practice Address - Street 1:1420 VICEROY DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-2208
Practice Address - Country:US
Practice Address - Phone:214-358-2300
Practice Address - Fax:214-366-6088
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker