Provider Demographics
NPI:1821753369
Name:BUSCH, ALEXANDER (PHD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:BUSCH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 E BAY ST # 233
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-1592
Mailing Address - Country:US
Mailing Address - Phone:630-748-9570
Mailing Address - Fax:
Practice Address - Street 1:334 E BAY ST # 233
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-1592
Practice Address - Country:US
Practice Address - Phone:630-748-9570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-31
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1686103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical