Provider Demographics
NPI:1538784160
Name:BUSIC, MIKENDA PEARL
Entity type:Individual
Prefix:
First Name:MIKENDA
Middle Name:PEARL
Last Name:BUSIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 W 200 N
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ST. GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770
Mailing Address - Country:US
Mailing Address - Phone:435-375-8698
Mailing Address - Fax:
Practice Address - Street 1:SOUTHWEST BEHAVIORAL HEALTH CENTER
Practice Address - Street 2:474 W 200 N SUITE 300
Practice Address - City:ST.GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770
Practice Address - Country:US
Practice Address - Phone:435-634-5674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker