Provider Demographics
NPI:1275823692
Name:BUSH, TERRY BELL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:BELL
Last Name:BUSH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5051 GRANDE DR
Mailing Address - Street 2:APT I3
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8962
Mailing Address - Country:US
Mailing Address - Phone:850-341-9566
Mailing Address - Fax:
Practice Address - Street 1:1724 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-5725
Practice Address - Country:US
Practice Address - Phone:850-341-9566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW31771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical