Provider Demographics
NPI:1376912345
Name:BUSHELL, BRITTANEY (MA LCPC)
Entity Type:Individual
Prefix:
First Name:BRITTANEY
Middle Name:
Last Name:BUSHELL
Suffix:
Gender:F
Credentials:MA LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3317 W 95TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2243
Mailing Address - Country:US
Mailing Address - Phone:773-879-7529
Mailing Address - Fax:
Practice Address - Street 1:3317 W 95TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2243
Practice Address - Country:US
Practice Address - Phone:773-879-7529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.012023101YP2500X
IL178011318101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional