Derek Steven Bush, AMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

109691 Issued in CA

Practice address

28310 Roadside Dr Ste 254
Agoura Hills, CA 91301-4966

Phone

(747) 248-7638

NPI assigned

Dec 13, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jun 5, 2026 through Jun 5, 2028

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1639353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639353600000",
    "number": "1255090684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28310 ROADSIDE DR STE 254",
            "city": "AGOURA HILLS",
            "state": "CA",
            "postal_code": "913014966",
            "telephone_number": "747-248-7638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28310 ROADSIDE DR STE 254",
            "city": "AGOURA HILLS",
            "state": "CA",
            "postal_code": "913014966",
            "telephone_number": "747-248-7638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSH",
        "first_name": "DEREK",
        "middle_name": "STEVEN",
        "credential": "AMFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-12-13",
        "last_updated": "2021-12-13",
        "certification_date": "2021-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "109691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "derek@canyoncreektherapists.com",
            "affiliation": "N",
            "endpointDescription": "Professional Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "28310 Roadside Dr Ste 254",
            "city": "Agoura Hills",
            "state": "CA",
            "country_code": "US",
            "postal_code": "913014966",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Tara K Buran
• Barbara Butler, DDS
• Chris Byers, MA, CCC-SLP
• Alison Cabanillas
• Jennifer Rebecca Calderon, LMFT, LPCC
• California Interventional Pain Institute, LLC.

• Marriage & Family Therapist in Agoura Hills, CA
• Providers in Agoura Hills, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.