Provider Demographics
NPI:1184047011
Name:BUSH, MS.ED, NCC, PCC-S, LLC, STEVEN CLARK (LPCC-S, LICDC-CS)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:CLARK
Last Name:BUSH, MS.ED, NCC, PCC-S, LLC
Suffix:
Gender:M
Credentials:LPCC-S, LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 PINE ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-1255
Mailing Address - Country:US
Mailing Address - Phone:937-417-8340
Mailing Address - Fax:937-237-8252
Practice Address - Street 1:5658 CEDARWOOD DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:OH
Practice Address - Zip Code:45338-9000
Practice Address - Country:US
Practice Address - Phone:937-237-5001
Practice Address - Fax:937-237-8252
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-29
Last Update Date:2015-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH975982101YA0400X
OHE. 0500534101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH975982OtherCHEMICAL DEPENDENCY PROFESSIONALS BOARD
OHE. 0500534OtherCOUNSELOR AND SOCIAL WORKER, MARRIAGE AND FAMILY THERAPIST BOARD