Organization
EVERGLADE PSYCHOTHERAPY GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL J BUSH PHD, THM, MDIV, MA (DIRECTOR)
(513) 341-5241
Entity
Organization
Contact information
Practice address
73 CAVALIER BLVD STE 321, FLORENCE, KY 41042-5185
(513) 341-5241
Mailing address
10228 HEMPSTEADE DR, UNION, KY 41091-9484
(513) 341-5241
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
—
—
Other
Enumeration date
03/11/2021
Last updated
03/11/2021
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