Provider Demographics
NPI:1619116720
Name:BUSH, WILLIAM WARD (MA LMFT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:WARD
Last Name:BUSH
Suffix:
Gender:M
Credentials:MA LMFT
Other - Prefix:MR
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:BUSH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA LMFT
Mailing Address - Street 1:1221 W CAMPBELL RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2967
Mailing Address - Country:US
Mailing Address - Phone:972-918-9100
Mailing Address - Fax:
Practice Address - Street 1:1221 W CAMPBELL RD
Practice Address - Street 2:SUITE 109
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2967
Practice Address - Country:US
Practice Address - Phone:972-918-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4534101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health