Provider Demographics
NPI:1598882201
Name:BUSH, PATRICIA J (LPCMH, MS, BS, AA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:BUSH
Suffix:
Gender:F
Credentials:LPCMH, MS, BS, AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 ELLEN DR
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-1128
Mailing Address - Country:US
Mailing Address - Phone:302-395-0677
Mailing Address - Fax:
Practice Address - Street 1:401 N BROAD ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-1037
Practice Address - Country:US
Practice Address - Phone:302-376-0621
Practice Address - Fax:302-376-6219
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC0000402101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health