Provider Demographics
NPI:1437905981
Name:BUSH, BRANDI (CADCA1, APSS, CSA)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:BUSH
Suffix:
Gender:F
Credentials:CADCA1, APSS, CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 RING RD STE 155
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-8790
Mailing Address - Country:US
Mailing Address - Phone:844-473-6378
Mailing Address - Fax:
Practice Address - Street 1:400 RING RD STE 155
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-8790
Practice Address - Country:US
Practice Address - Phone:270-319-9899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1211852175T00000X
KY295967101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty