Individual
SUE MARIE BUSHROW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
808 MIMOSA AVE, JASPER, TN 37347-3007
(951) 249-3774
(423) 403-7875
Mailing address
808 MIMOSA AVE, JASPER, TN 37347-3007
(951) 249-3774
(423) 403-7875
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1948
TENNESSEE LMFT
TN
01
—
490
LMFT TLHT
FL
Enumeration date
03/19/2012
Last updated
02/28/2025
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