Healthcare Provider Details

I. General information

NPI: 1669840153
Provider Name (Legal Business Name): ASHLEY BUSCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20494 NW 27TH ST
MORRISTON FL
32668-7904
US

IV. Provider business mailing address

3001 SE LAKE WEIR AVE APT 1209
OCALA FL
34471-6732
US

V. Phone/Fax

Practice location:
  • Phone: 352-465-1639
  • Fax:
Mailing address:
  • Phone: 352-895-4858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: