Provider Demographics
NPI:1548751522
Name:BUSH, PIA ANDREA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PIA
Middle Name:ANDREA
Last Name:BUSH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 COAL AVE SW APT 262
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3071
Mailing Address - Country:US
Mailing Address - Phone:757-685-2310
Mailing Address - Fax:
Practice Address - Street 1:4270 S DECATUR BLVD STE A10A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-6801
Practice Address - Country:US
Practice Address - Phone:702-912-5559
Practice Address - Fax:702-912-5536
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist