Provider Demographics
NPI:1982407334
Name:BUSCH, KATRENIA GRACE (BEHAVIORAL TECH)
Entity type:Individual
Prefix:MS
First Name:KATRENIA
Middle Name:GRACE
Last Name:BUSCH
Suffix:
Gender:
Credentials:BEHAVIORAL TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2662 LINDHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48632-9151
Mailing Address - Country:US
Mailing Address - Phone:989-357-4827
Mailing Address - Fax:
Practice Address - Street 1:2662 LINDHAVEN DR
Practice Address - Street 2:
Practice Address - City:LAKE
Practice Address - State:MI
Practice Address - Zip Code:48632-9151
Practice Address - Country:US
Practice Address - Phone:989-357-4827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician