Provider Demographics
NPI:1164651220
Name:BUSCH, NANCY ANN (LCSW,)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
Last Name:BUSCH
Suffix:
Gender:F
Credentials:LCSW,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13813 N 103RD WAY
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-2219
Mailing Address - Country:US
Mailing Address - Phone:904-303-3549
Mailing Address - Fax:
Practice Address - Street 1:13813 N 103RD WAY
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-2219
Practice Address - Country:US
Practice Address - Phone:904-303-3549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-10
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS247421041C0700X
FL9802101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical