Individual
THOMAS BUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
1311 N DIXIE HWY, ELIZABETHTOWN, KY 42701-2621
(270) 765-2605
(270) 766-1222
Mailing address
107 CRANES ROOST CT, ELIZABETHTOWN, KY 42701-3650
(270) 765-2605
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0563
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000044420
ANTHEM
KY
01
—
11574907
CAQH
—
05
—
30605018
—
KY
01
—
341172
TRICARE
KY
Enumeration date
06/03/2006
Last updated
07/08/2007
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