Provider Demographics
NPI:1801359369
Name:BUSHONG, CAMMY LYNN (MS, LPC, CAADC, CCTP)
Entity type:Individual
Prefix:MRS
First Name:CAMMY
Middle Name:LYNN
Last Name:BUSHONG
Suffix:
Gender:
Credentials:MS, LPC, CAADC, CCTP
Other - Prefix:MS
Other - First Name:CAMMY
Other - Middle Name:L
Other - Last Name:BECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC, CAADC, CCTP
Mailing Address - Street 1:3614 PINE OAK AVE SW APT 304
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-3900
Mailing Address - Country:US
Mailing Address - Phone:616-460-2164
Mailing Address - Fax:
Practice Address - Street 1:3614 PINE OAK AVE SW APT 304
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-3900
Practice Address - Country:US
Practice Address - Phone:616-493-2683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-11
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014830101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8970120Medicaid