Provider Demographics
NPI:1154814218
Name:BUSH, ANGELA KAY (LCSW-S)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:KAY
Last Name:BUSH
Suffix:
Gender:F
Credentials:LCSW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 N HALL ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:TX
Mailing Address - Zip Code:76531-1409
Mailing Address - Country:US
Mailing Address - Phone:254-592-7403
Mailing Address - Fax:
Practice Address - Street 1:511 N HALL ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:TX
Practice Address - Zip Code:76531-1409
Practice Address - Country:US
Practice Address - Phone:254-592-7403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX385899501Medicaid