Provider Demographics
NPI:1124422878
Name:BUSCH, ROWLIN (MED, LPC, CMHC, NCC)
Entity type:Individual
Prefix:
First Name:ROWLIN
Middle Name:
Last Name:BUSCH
Suffix:
Gender:M
Credentials:MED, LPC, CMHC, NCC
Other - Prefix:
Other - First Name:ROWLIE
Other - Middle Name:
Other - Last Name:BUSCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED, LPC, CMHC, NCC
Mailing Address - Street 1:601 MATTERHORN DR
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-5238
Mailing Address - Country:US
Mailing Address - Phone:970-708-7781
Mailing Address - Fax:
Practice Address - Street 1:601 MATTERHORN DR
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-5238
Practice Address - Country:US
Practice Address - Phone:970-708-7781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-09
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC0013264101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional