Individual
GLADYS T BUSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
HEALTH COACH CCMA
Contact information
Practice address
9501 CHASE WAY, SHREVEPORT, LA 71118-4619
(318) 773-0657
(318) 688-1559
Mailing address
PO BOX 19284, SHREVEPORT, LA 71149-0284
(318) 773-0657
Taxonomy
Speciality
Code
Description
License number
State
405300000X
Prevention Professional
Primary
60312804
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K5C6Y6M8
CCMA
LA
Enumeration date
01/30/2020
Last updated
01/30/2020
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