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TRACIE L BUSH M.A., CKPMT

Mental Health >> Counselor >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1043689011

Individual Registrant:
 TRACIE L BUSH M.A., CKPMT
Gender: F
Not Sole Proprietor

Location and contact information for practice:
79 COUNTRY WAY  MADISON, CT 06443-1759 US
Tel: 203-848-7169  Fax: --

Contact information for business:
79 COUNTRY WAY  MADISON, CT 06443-1759 US
Tel: 203-848-7169  Fax: --

Registration Information:
NPI: 1043689011
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
N101YM0800XBehavioral Health & Social Service Providers
Counselor
Mental Health
Y103K00000X

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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