Most Relevant Information
Provider Data
| NPI Number: | 1003818048 |
| Provider Name: | KEVIN BUSHUR MS/LCPC |
| Entity Type: | Individual |
| Taxonomy Code: | 101Y00000X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/10/2005 |
| Last Updated: | 07/08/2007 |
Provider Practice Location
1200 N 4TH ST
EFFINGHAM
IL
624013032
Practice Location Phone/Fax
| Phone: | 2173477179 |
| Fax: |
Provider Mailing Location
17454 N 1400TH ST
EFFINGHAM
IL
624016707
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |