Bushur, Kelly A
Bushur, Kelly A is an individual health care provider with primary practice located at 400 S Lewis Ln , Carbondale IL 62901-3547. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Bushur, Kelly A can be contacted via phone (618) 519-9900.Contact Information
Primary practice address
400 S Lewis Ln
Carbondale IL 62901-3547
Phone: (618) 519-9900
Fax: (618) 529-1384
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 071005772 | Illinois |
Profile Details
| NPI number | 1629248406 |
|---|---|
| LBN Legal business name | Bushur, Kelly A |
| Credentials | CP PH.D |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 7th, 2008 |
| Last updated | Oct 23rd, 2014 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1629248406 | NPPES |
| Illinois | MEDICAID | 370966854006 | |
| Illinois | MEDICAID | 370966854015 | |
| Illinois | MEDICAID | 370966854002 | |
| Illinois | MEDICAID | 370966854024 | |
| Illinois | MEDICAID | 370966854005 | |
| Illinois | Other | 640701 |
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