Provider Demographics
NPI:1942257803
Name:BUSTARD, GEORGE I JR (PASTORAL COUNSELOR)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:I
Last Name:BUSTARD
Suffix:JR
Gender:M
Credentials:PASTORAL COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 FLOURTOWN AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:WYNDMOOR
Mailing Address - State:PA
Mailing Address - Zip Code:19038-7976
Mailing Address - Country:US
Mailing Address - Phone:215-233-3994
Mailing Address - Fax:215-233-3997
Practice Address - Street 1:8200 FLOURTOWN AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:WYNDMOOR
Practice Address - State:PA
Practice Address - Zip Code:19038-7976
Practice Address - Country:US
Practice Address - Phone:215-233-3994
Practice Address - Fax:215-233-3997
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YP1600X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral