Provider Demographics
NPI:1063624690
Name:BUSHONG, DEBRA MOORE (LPC-S)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:MOORE
Last Name:BUSHONG
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:S
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:6060 N CENTRAL EXPY STE 500
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-5249
Mailing Address - Country:US
Mailing Address - Phone:469-727-8255
Mailing Address - Fax:214-764-8501
Practice Address - Street 1:6060 N CENTRAL EXPY STE 500
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-5249
Practice Address - Country:US
Practice Address - Phone:469-727-8255
Practice Address - Fax:214-764-8501
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59919101Y00000X, 101YM0800X, 252Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX59919OtherTEXAS STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS