Provider Demographics
NPI:1528409364
Name:BUSHONG, TIMOTHY (MA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:BUSHONG
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 MARIETTA AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-3239
Mailing Address - Country:US
Mailing Address - Phone:717-399-8288
Mailing Address - Fax:
Practice Address - Street 1:822 MARIETTA AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-3239
Practice Address - Country:US
Practice Address - Phone:717-399-8288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor