# KICK THE HABIT ADDICTION MEDICINE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780154195
- **Authorized official:** ROBERT JOEL BUSH MD (CEO)
- **Authorized official phone:** (949) 237-2874

## Contact information

- **Practice address:** 74 S 360 E, AMERICAN FORK, UT 84003-2590
- **Practice address phone:** (949) 237-2874
- **Practice address fax:** (844) 240-9439
- **Mailing address:** 74 S 360 E, AMERICAN FORK, UT 84003-2590
- **Mailing address phone:** (949) 237-2874
- **Mailing address fax:** (844) 240-9439

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/28/2018
- **Last updated:** 03/05/2019