Provider Demographics
NPI:1699496224
Name:BUSH, ANISHA
Entity type:Individual
Prefix:
First Name:ANISHA
Middle Name:
Last Name:BUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9722 GASTON RD STE 150
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-7944
Mailing Address - Country:US
Mailing Address - Phone:314-397-3914
Mailing Address - Fax:
Practice Address - Street 1:9722 GASTON RD STE 150
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-7944
Practice Address - Country:US
Practice Address - Phone:832-570-3130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional