Provider Demographics
NPI:1760875769
Name:BUSTRUM, JOY MICHELLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOY
Middle Name:MICHELLE
Last Name:BUSTRUM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:131 N EL MOLINO AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1873
Mailing Address - Country:US
Mailing Address - Phone:626-389-7411
Mailing Address - Fax:626-449-5465
Practice Address - Street 1:131 N EL MOLINO AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1873
Practice Address - Country:US
Practice Address - Phone:626-389-7411
Practice Address - Fax:626-449-5465
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-15
Last Update Date:2015-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19859103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical