Provider Demographics
NPI:1316653298
Name:BUSHNELL, MASON (LLMSW)
Entity type:Individual
Prefix:
First Name:MASON
Middle Name:
Last Name:BUSHNELL
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3708 PRATT RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-1433
Mailing Address - Country:US
Mailing Address - Phone:201-675-1937
Mailing Address - Fax:
Practice Address - Street 1:2010 HOGBACK RD STE 6G
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-8800
Practice Address - Country:US
Practice Address - Phone:734-386-0041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical