Provider Demographics
NPI:1245530310
Name:BUSH, JENNA ANN
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:ANN
Last Name:BUSH
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 1:230 FRENCHYS CV
Mailing Address - Street 2:APT 51
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-9152
Mailing Address - Country:US
Mailing Address - Phone:805-444-2182
Mailing Address - Fax:
Practice Address - Street 1:125 W THOUSAND OAKS BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4412
Practice Address - Country:US
Practice Address - Phone:805-777-3542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-23
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)