Provider Demographics
NPI:1649504416
Name:BUSH, DEANNE JEAN I
Entity type:Individual
Prefix:
First Name:DEANNE
Middle Name:JEAN
Last Name:BUSH
Suffix:I
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 1:18777 INNSBROOK DR
Mailing Address - Street 2:APT 402
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-2221
Mailing Address - Country:US
Mailing Address - Phone:313-461-9510
Mailing Address - Fax:
Practice Address - Street 1:54 SENECA ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2349
Practice Address - Country:US
Practice Address - Phone:248-836-0196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health