Provider Demographics
NPI:1245405539
Name:BUSCH, SARAH L (LPCC)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:L
Last Name:BUSCH
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 RAILROAD ST SE
Mailing Address - Street 2:
Mailing Address - City:PINE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55063-1540
Mailing Address - Country:US
Mailing Address - Phone:320-629-7600
Mailing Address - Fax:651-925-0071
Practice Address - Street 1:900 GOLF AVE SW
Practice Address - Street 2:
Practice Address - City:PINE CITY
Practice Address - State:MN
Practice Address - Zip Code:55063-5015
Practice Address - Country:US
Practice Address - Phone:320-629-7600
Practice Address - Fax:651-925-0071
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3663-125101YM0800X
MN00968101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1245405539Medicaid
WI40933000Medicaid