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TRACIE L BUSH M.A., CKPMT
Mental Health >> Counselor >> Behavioral Health & Social Service ProvidersRegistrant NPI Number: 1043689011
Individual Registrant: TRACIE L BUSH M.A., CKPMT
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
79 COUNTRY WAY MADISON, CT 06443-1759 US
Tel: 203-848-7169 Fax: --
Tel: 203-848-7169 Fax: --
Contact information for business:
79 COUNTRY WAY MADISON, CT 06443-1759 US
Tel: 203-848-7169 Fax: --
Tel: 203-848-7169 Fax: --
Registration Information:
NPI: 1043689011
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 101YM0800X | Behavioral Health & Social Service Providers Counselor Mental Health | ||
| Y | 103K00000X |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
