Provider Demographics
NPI:1386102408
Name:BUSCH, NICOLE MARIE (MA, LMFT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:BUSCH
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 EAGLEVIEW BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1150
Mailing Address - Country:US
Mailing Address - Phone:610-422-3064
Mailing Address - Fax:484-870-9846
Practice Address - Street 1:397 EAGLEVIEW BLVD STE 120
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1150
Practice Address - Country:US
Practice Address - Phone:610-422-3064
Practice Address - Fax:484-870-9846
Is Sole Proprietor?:No
Enumeration Date:2019-03-07
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF001212106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health