Basic Information
| Provider Information | |||||||||
| NPI: | 1003466731 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUSTOS | ||||||||
| FirstName: | JOSUE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5801 N 51ST AVE | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853016057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6026856000 | ||||||||
| FaxNumber: | 6029300358 | ||||||||
| Practice Location | |||||||||
| Address1: | 2345 W GLENDALE AVE | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850217672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022790008 | ||||||||
| FaxNumber: | 6022792004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2019 | ||||||||
| LastUpdateDate: | 05/05/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCSW-17968 | AZ | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.