Provider Demographics
NPI:1932983103
Name:BUSH, TRISHA (MSW)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:
Last Name:BUSH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3565 S STATE ROAD 13
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-9162
Mailing Address - Country:US
Mailing Address - Phone:260-563-8453
Mailing Address - Fax:
Practice Address - Street 1:1502 W NELSON ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-3518
Practice Address - Country:US
Practice Address - Phone:260-563-8453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker