Provider Demographics
NPI:1609042654
Name:J BARRY BUSH, INC
Entity Type:Organization
Organization Name:J BARRY BUSH, INC
Other - Org Name:KAY F. BUSH, MA, LPC, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-824-4200
Mailing Address - Street 1:415 N CUTTING AVE
Mailing Address - Street 2:
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-5963
Mailing Address - Country:US
Mailing Address - Phone:337-824-4200
Mailing Address - Fax:337-824-4201
Practice Address - Street 1:415 N CUTTING AVE
Practice Address - Street 2:
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-5963
Practice Address - Country:US
Practice Address - Phone:337-824-4200
Practice Address - Fax:337-824-4201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2939261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center