Provider Demographics
NPI:1841565108
Name:BUSHROW, SUE MARIE (LMFT)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:MARIE
Last Name:BUSHROW
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43385 BUSINESS PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-3692
Mailing Address - Country:US
Mailing Address - Phone:951-249-3774
Mailing Address - Fax:234-037-8754
Practice Address - Street 1:808 CHESTNUT ST # 1015
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-2510
Practice Address - Country:US
Practice Address - Phone:951-249-3774
Practice Address - Fax:423-403-7875
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL490OtherLMFT TLHT
TN1948OtherTENNESSEE LMFT