Provider Demographics
NPI:1659980498
Name:BUSH, JAMIE ROSE
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:ROSE
Last Name:BUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:ROSE
Other - Last Name:HERSTEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:271 ALEXANDRA DR UNIT 11
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-2883
Mailing Address - Country:US
Mailing Address - Phone:724-681-2473
Mailing Address - Fax:
Practice Address - Street 1:230 N CRAIG ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-1565
Practice Address - Country:US
Practice Address - Phone:610-892-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012448101YP2500X
SC7696101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional