Individual
NICKOLAS BUSHON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.A., TLLP
Contact information
Practice address
1555 INDUSTRIAL DR, OWOSSO, MI 48867-9775
(989) 723-6791
(989) 725-5061
Mailing address
PO BOX 428, OWOSSO, MI 48867-0428
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301016436
MI
Other
Enumeration date
11/05/2015
Last updated
11/05/2015
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