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Provider Information for 1073382586


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Ms. MATTIE GATES BUSH LMFT


Other Names:  
Other Name: 
Mrs. MATTIE GLEN GATES NA

Sex: Female

NPI: 1073382586
Last Updated: 2023-12-26
Certification Date: 2023-12-21

Details

NameValue
NPI1073382586
Enumeration Date2023-12-26
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 37 SHARP ST
FORSYTH, GA 31029-1721
United States

Phone: 478-361-9774 | Fax:
 
Primary Practice Address 37 SHARP ST
FORSYTH, GA 31029-1721
United States

Phone: 478-361-9774 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 193400000X - Single Specialty Group
101YM0800X - Counselor - Mental Health
GA000773