Provider Demographics
NPI:1538480124
Name:BUSH, REBECCA NAOMI (LPC)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:NAOMI
Last Name:BUSH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:NAOMI
Other - Last Name:WASSERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:447 SE BASELINE ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4103
Mailing Address - Country:US
Mailing Address - Phone:503-640-4222
Mailing Address - Fax:503-640-0334
Practice Address - Street 1:447 SE BASELINE ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4103
Practice Address - Country:US
Practice Address - Phone:503-640-4222
Practice Address - Fax:503-640-0334
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2309101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional