Provider Demographics
NPI:1568848489
Name:BUSHEY, SAMANTHA
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:BUSHEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 N RODNEY PARHAM RD STE B
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-1685
Mailing Address - Country:US
Mailing Address - Phone:501-389-8100
Mailing Address - Fax:
Practice Address - Street 1:1111 S BOWMAN RD STE B4
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3766
Practice Address - Country:US
Practice Address - Phone:501-747-1071
Practice Address - Fax:501-747-1186
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional