Provider Demographics
NPI:1447337795
Name:BUSHMAN, BENJAMIN (PHD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:BUSHMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6812 N ORACLE RD STE 124
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-4256
Mailing Address - Country:US
Mailing Address - Phone:520-297-9878
Mailing Address - Fax:520-297-2242
Practice Address - Street 1:6812 N ORACLE RD STE 124
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-4256
Practice Address - Country:US
Practice Address - Phone:520-297-9878
Practice Address - Fax:520-297-2242
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3750103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0158880OtherBLUE CROSS BLUE SHIELD
AZAZ0158880OtherBLUE CROSS BLUE SHIELD