Provider Demographics
NPI:1154627172
Name:NUSS, NATASHA NICHOLE (BA MHP)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:NICHOLE
Last Name:NUSS
Suffix:
Gender:F
Credentials:BA MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 W SPRINGFIELD AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-4755
Mailing Address - Country:US
Mailing Address - Phone:217-495-1499
Mailing Address - Fax:
Practice Address - Street 1:614 W HEALEY ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-5025
Practice Address - Country:US
Practice Address - Phone:217-398-1658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker