Provider Demographics
NPI:1568049062
Name:BUSH, DANIEL J (PHD, MA, MDIV, LPCC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:BUSH
Suffix:
Gender:M
Credentials:PHD, MA, MDIV, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 CAVALIER BLVD STE 212
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-3958
Mailing Address - Country:US
Mailing Address - Phone:859-935-0110
Mailing Address - Fax:859-657-7011
Practice Address - Street 1:75 CAVALIER BLVD STE 212
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-3958
Practice Address - Country:US
Practice Address - Phone:859-935-0110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY283449101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health