Individual
MS. CRYSTAL LYNN BUSHONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2105 DEMERSE AVE, PRESCOTT, AZ 86301-1013
(928) 717-8834
Mailing address
2105 DEMERSE AVE, PRESCOTT, AZ 86301-1013
(928) 717-8834
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
12/17/2007
Last updated
12/17/2007
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