Provider Demographics
NPI:1689489254
Name:BUSCH, VICTORIA LESLEY ANN
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LESLEY ANN
Last Name:BUSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 S PAUL ST
Mailing Address - Street 2:
Mailing Address - City:ELLETTSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47429-1822
Mailing Address - Country:US
Mailing Address - Phone:267-882-8881
Mailing Address - Fax:
Practice Address - Street 1:254 E ONTARIO ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-1649
Practice Address - Country:US
Practice Address - Phone:267-882-8881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health