Provider Demographics
NPI:1538212709
Name:BUSH-TYLDSLEY, ANDREA (MED LPC)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:BUSH-TYLDSLEY
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5533 E BELL RD
Mailing Address - Street 2:SUITE 127
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-1228
Mailing Address - Country:US
Mailing Address - Phone:602-867-4905
Mailing Address - Fax:602-867-4824
Practice Address - Street 1:5533 E BELL RD
Practice Address - Street 2:SUITE 127
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-1228
Practice Address - Country:US
Practice Address - Phone:602-867-4905
Practice Address - Fax:602-867-4824
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-10879101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional