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General NPI Number Information
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NPI Number | 1639622780
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Entity Type | Individual
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Provider Name | LUISA JULIA VANDEN BUSH LPC, CSAC
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Gender | Female
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Dates
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Enumeration Date | 07/25/2016
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Last Update Date | 06/27/2023
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Provider Practice Location Address
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Address Line | 2607 N GRANDVIEW BLVD
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City | WAUKESHA
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State | WI
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Zip | 53188-1686
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Country | US
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Telephone | 262-515-9079
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Fax |
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Provider Business Mailing Address
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Address Line | 9740 W COLD SPRING RD
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City | GREENFIELD
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State | WI
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Zip | 53228-2720
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Country | US
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Telephone | 262-515-9079
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6984-125
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License Number State | WI
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