Provider Demographics
NPI:1578270617
Name:BUSH, MORGAN JAYDEN (RBT)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:JAYDEN
Last Name:BUSH
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 WESTVIEW WAY APT 12
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:40313-9674
Mailing Address - Country:US
Mailing Address - Phone:606-225-3358
Mailing Address - Fax:
Practice Address - Street 1:805 ALEXA DR
Practice Address - Street 2:
Practice Address - City:MOUNT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1000
Practice Address - Country:US
Practice Address - Phone:606-225-3358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician