| NPI | 1114414174 |
|---|---|
| Former Name | KELLIE MARIE BUSH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.169323) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.165953) |
| 175T00000X Peer Specialist (Licence: OH CDCA.165953) | |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2020-10-23 |