Provider Demographics
NPI:1932241767
Name:BUSH, JOHN C (PSYCHOLOGY)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:BUSH
Suffix:
Gender:M
Credentials:PSYCHOLOGY
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Mailing Address - Street 1:1819 CENTRAL AVE SO
Mailing Address - Street 2:SOUTH CENTRAL BLDG A STE 111
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032
Mailing Address - Country:US
Mailing Address - Phone:253-852-5503
Mailing Address - Fax:253-852-3612
Practice Address - Street 1:1819 CENTRAL AVE SO
Practice Address - Street 2:SOUTH CENTRAL BLDG A STE 111
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032
Practice Address - Country:US
Practice Address - Phone:253-852-5503
Practice Address - Fax:253-852-3612
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPY00000527103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical