Provider Demographics
NPI:1639622780
Name:VANDEN BUSH, LUISA JULIA (LPC, CSAC)
Entity type:Individual
Prefix:
First Name:LUISA
Middle Name:JULIA
Last Name:VANDEN BUSH
Suffix:
Gender:F
Credentials:LPC, CSAC
Other - Prefix:
Other - First Name:LUISA
Other - Middle Name:JULIA
Other - Last Name:MORALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:9740 W COLD SPRING RD
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-2720
Mailing Address - Country:US
Mailing Address - Phone:262-515-9079
Mailing Address - Fax:
Practice Address - Street 1:2607 N GRANDVIEW BLVD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1686
Practice Address - Country:US
Practice Address - Phone:262-515-9079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-25
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6984-125101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor