Provider Demographics
NPI:1811228075
Name:BUSHY, CHRISTINE J
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:J
Last Name:BUSHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 25TH ST S
Mailing Address - Street 2:PO BOX 9859
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2311
Mailing Address - Country:US
Mailing Address - Phone:701-451-4900
Mailing Address - Fax:701-451-4893
Practice Address - Street 1:224 4TH ST NW STE 5
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-2960
Practice Address - Country:US
Practice Address - Phone:701-662-6776
Practice Address - Fax:701-662-6889
Is Sole Proprietor?:No
Enumeration Date:2010-01-27
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND630-3-15-09A101YM0800X
ND630-3-15-09-316101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health