Provider Demographics
NPI:1417208380
Name:BUSCH, JONATHAN JAY (LPC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:JAY
Last Name:BUSCH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37451 252ND ST
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:SD
Mailing Address - Zip Code:57383-5620
Mailing Address - Country:US
Mailing Address - Phone:605-682-1484
Mailing Address - Fax:
Practice Address - Street 1:37451 252ND ST
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:SD
Practice Address - Zip Code:57383-5620
Practice Address - Country:US
Practice Address - Phone:605-682-1484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDORDAINED 248986 2101YP1600X
SDLPC7199101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral