Provider Demographics
NPI:1205820735
Name:LUSH, DALE RICHARD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:RICHARD
Last Name:LUSH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16017 CEDAR CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-1748
Mailing Address - Country:US
Mailing Address - Phone:402-330-8658
Mailing Address - Fax:
Practice Address - Street 1:55 MDOS SGO
Practice Address - Street 2:2501 CAPEHART ROAD
Practice Address - City:OFFUTT A F B
Practice Address - State:NE
Practice Address - Zip Code:68113-1712
Practice Address - Country:US
Practice Address - Phone:402-294-7411
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical