Provider Demographics
NPI:1679379838
Name:BUSH, MEMORIE NICOLE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:MEMORIE
Middle Name:NICOLE
Last Name:BUSH
Suffix:
Gender:
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 39321
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-0321
Mailing Address - Country:US
Mailing Address - Phone:317-397-2843
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 39321
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46239-0321
Practice Address - Country:US
Practice Address - Phone:317-397-2843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-19
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical