Provider Demographics
NPI:1629472675
Name:CAROLYN BUSHONG PSYCHOTHERAPY ASSOC.
Entity Type:Organization
Organization Name:CAROLYN BUSHONG PSYCHOTHERAPY ASSOC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:NORDIN
Authorized Official - Last Name:BUSHONG
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:303-333-1888
Mailing Address - Street 1:21994 N TURKEY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:CO
Mailing Address - Zip Code:80465-9009
Mailing Address - Country:US
Mailing Address - Phone:303-333-1888
Mailing Address - Fax:
Practice Address - Street 1:21994 N TURKEY CREEK RD
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:CO
Practice Address - Zip Code:80465-9009
Practice Address - Country:US
Practice Address - Phone:303-333-1888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO951251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health