Individual
JORDAN TYLER BUSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
727 E WYANDOTTE AVE, MCALESTER, OK 74501-5451
(918) 420-5343
Mailing address
PO BOX 292, WHITEFIELD, OK 74472-0292
(918) 448-2232
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
OK
Other
Enumeration date
02/15/2019
Last updated
02/16/2019
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