Provider Demographics
NPI:1962979518
Name:BUSH, LOUISE (LCPC)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:
Last Name:BUSH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:LOUISE
Other - Middle Name:
Other - Last Name:SHERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:811 CHICAGO AVENUE
Mailing Address - Street 2:APT 708
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2398
Mailing Address - Country:US
Mailing Address - Phone:314-229-2728
Mailing Address - Fax:
Practice Address - Street 1:811 CHICAGO AVENUE
Practice Address - Street 2:APT 708
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-2398
Practice Address - Country:US
Practice Address - Phone:314-229-2728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-31
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180012205101YP2500X, 102L00000X, 101YM0800X
IL178010615101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health