Doctor Name: | STACIE BUSH |
NPI Number: | 1265726145 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 1147 |
Business Practice Address: | 130 S. Joe B. Hall Ave Shepherdsville, KY - 401650690 |
Business Phone Number: | 5025898600 |
Business Fax Number: | 5025898771 |
Mailing Address: | 101 W Muhammad Ali Blvd, LOUISVILLE |
State: | KY |
Postal Code: | 402021423 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 06/08/2011 |
NPI Last Update Date: | 06/08/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 1147 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |