Active NPI
Jacqueline Bush, LMFT, BC-TMH
- Marriage & Family Therapist
- Charlotte, NC
National Provider Identifier
1073012647
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 2118
- Practice address
- 227 W 4TH St Ste 321
Charlotte, NC 28202-1545 - Phone
- (704) 879-1179
- Fax
- (704) 490-4274
- NPI assigned
- Feb 8, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 10
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 2118 | NC | Primary |
| Marriage & Family Therapist | 106H00000X | MFT002250 | GA | |
| Marriage & Family Therapist | 106H00000X | 0717002128 | VA | |
| Marriage & Family Therapist | 106H00000X | LCM1108 | MD | |
| Marriage & Family Therapist | 106H00000X | TPMF251 | FL | |
| Marriage & Family Therapist | 106H00000X | MFT1586 | LA | |
| Marriage & Family Therapist | 106H00000X | LMFT200001420 | DC | |
| Marriage & Family Therapist | 106H00000X | 206218 | TX | |
| Marriage & Family Therapist | 106H00000X | 7054 | SC | |
| Mental Health Counselor | 101YM0800X |
Addresses
Primary practice location
227 W 4TH St Ste 321
Charlotte, NC 28202-1545
Mailing address
PO Box 82406
Baton Rouge, LA 70884-2406
Phone (704) 879-1179
Other practice location 1
10202 Perkins Rowe Ste E160
Baton Rouge, LA 70810-2067
Phone (704) 879-1179
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LMFT200001420 | DC | MD | Marriage & Family Therapist |
| TPMF251 | FL | MD | Marriage & Family Therapist |
| MFT002250 | GA | MD | Marriage & Family Therapist |
| MFT1586 | LA | MD | Marriage & Family Therapist |
| LCM1108 | MD | MD | Marriage & Family Therapist |
| 206218 | TX | MD | Marriage & Family Therapist |
| 0717002128 | VA | MD | Marriage & Family Therapist |
| 2118 | NC | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Transformative Vision PLLC | Current | Accepting new patients | |
| Transformative Vision | Marriage & Family Therapist | Current | Accepting new patients |
Locations
10202 Perkins Rowe
Ste 160
Baton Rouge, LA 70810
227 W 4th St
Charlotte, NC 28202
Phone (704) 879-1179
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Charlotte, NC
- NPI 1255808036
Marriage & Family Therapist
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Charlotte, NC
- NPI 1952923039
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1518048000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1772582400000",
"number": "1073012647",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 82406",
"city": "BATON ROUGE",
"state": "LA",
"postal_code": "708842406",
"telephone_number": "704-879-1179",
"fax_number": "704-490-4274"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "227 W 4TH ST STE 321",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282021545",
"telephone_number": "704-879-1179",
"fax_number": "704-490-4274"
}
],
"practiceLocations": [
{
"address_1": "10202 Perkins Rowe Ste E160",
"address_purpose": "LOCATION",
"city": "Baton Rouge",
"state": "LA",
"postal_code": "708102067",
"country_code": "US",
"telephone_number": "704-879-1179",
"fax_number": "704-490-4274",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BUSH",
"first_name": "JACQUELINE",
"credential": "LMFT, BC-TMH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-02-08",
"last_updated": "2026-03-04",
"certification_date": "2026-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Marriage & Family Therapist",
"state": "NC",
"license": "2118",
"primary": true
},
{
"code": "106H00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Marriage & Family Therapist",
"state": "GA",
"license": "MFT002250",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Marriage & Family Therapist",
"state": "VA",
"license": "0717002128",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Marriage & Family Therapist",
"state": "MD",
"license": "LCM1108",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Marriage & Family Therapist",
"state": "FL",
"license": "TPMF251",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Marriage & Family Therapist",
"state": "LA",
"license": "MFT1586",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Marriage & Family Therapist",
"state": "DC",
"license": "LMFT200001420",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Marriage & Family Therapist",
"state": "TX",
"license": "206218",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Marriage & Family Therapist",
"state": "SC",
"license": "7054",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.