Everglade Psychotherapy Group LLC

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

Legal business name

EVERGLADE PSYCHOTHERAPY GROUP LLC

Practice address

73 Cavalier Blvd Ste 321
Florence, KY 41042-5185

Phone

(513) 341-5241

NPI assigned

Mar 11, 2021

Organization subpart

No

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

Authorized official

Name

Daniel J Bush, PHD, THM, MDIV, MANPI 1568049062

Title

Director

Phone

(513) 341-5241

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Daniel J Bush, PHD, MA, MDIV, LPCC

  • Mental Health Counselor
  • Florence, KY
  • NPI 1568049062
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1615420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615420800000",
    "number": "1356926372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10228 HEMPSTEADE DR",
            "city": "UNION",
            "state": "KY",
            "postal_code": "410919484",
            "telephone_number": "513-341-5241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "73 CAVALIER BLVD STE 321",
            "city": "FLORENCE",
            "state": "KY",
            "postal_code": "410425185",
            "telephone_number": "513-341-5241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGLADE PSYCHOTHERAPY GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-11",
        "last_updated": "2021-03-11",
        "certification_date": "2021-03-11",
        "status": "A",
        "authorized_official_last_name": "BUSH",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "513-341-5241",
        "authorized_official_credential": "PHD, THM, MDIV, MA"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Counseling Psychologist in Florence, KY
• Providers in Florence, KY by specialty
• Counseling Psychologist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.