Individual
MS. MAVIS A BUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
80 STATE HIGHWAY 310, SUITE 1, CANTON, NY 13617-1493
(315) 386-2189
(315) 386-2435
Mailing address
80 STATE HIGHWAY 310, SUITE 1, CANTON, NY 13617-1493
(315) 386-2189
(315) 386-2435
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
07/30/2007
Last updated
07/30/2007
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