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Individual
DR. THEODORE BUSH IV
Active
Individual
DR. THEODORE BUSH IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
101YP1600X
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
600723292
—
LA
Enumeration date
10/14/2015
Last updated
06/01/2018
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