Individual
TRACIE L BUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., CKPMT
Contact information
Practice address
79 COUNTRY WAY, MADISON, CT 06443-1759
(203) 848-7169
Mailing address
79 COUNTRY WAY, MADISON, CT 06443-1759
(203) 848-7169
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
09/21/2015
Last updated
09/21/2015
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