Provider Demographics
NPI:1740649490
Name:SCOTT D BUSH LLC
Entity type:Organization
Organization Name:SCOTT D BUSH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:D
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMHC
Authorized Official - Phone:407-230-4949
Mailing Address - Street 1:21001 REINDEER RD
Mailing Address - Street 2:
Mailing Address - City:CHRISTMAS
Mailing Address - State:FL
Mailing Address - Zip Code:32709-9122
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21001 REINDEER RD
Practice Address - Street 2:
Practice Address - City:CHRISTMAS
Practice Address - State:FL
Practice Address - Zip Code:32709-9122
Practice Address - Country:US
Practice Address - Phone:407-230-4949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10961251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health