Provider Demographics
NPI:1205119021
Name:BUSH, KRISTEN LEIGH KELLER (MA)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LEIGH KELLER
Last Name:BUSH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:332 HOPKINS DR
Mailing Address - Street 2:
Mailing Address - City:BOYCE
Mailing Address - State:VA
Mailing Address - Zip Code:22620-9719
Mailing Address - Country:US
Mailing Address - Phone:540-579-2318
Mailing Address - Fax:
Practice Address - Street 1:332 HOPKINS DR
Practice Address - Street 2:
Practice Address - City:BOYCE
Practice Address - State:VA
Practice Address - Zip Code:22620-9719
Practice Address - Country:US
Practice Address - Phone:540-579-2318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health