Provider Demographics
NPI:1225789845
Name:CUSICK PSYCHOTHERAPY
Entity Type:Organization
Organization Name:CUSICK PSYCHOTHERAPY
Other - Org Name:CUSICK PSYCHOTHERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:CUSICK
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP
Authorized Official - Phone:402-917-2570
Mailing Address - Street 1:725 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-5163
Mailing Address - Country:US
Mailing Address - Phone:402-917-2570
Mailing Address - Fax:402-941-7018
Practice Address - Street 1:725 E 5TH ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-5163
Practice Address - Country:US
Practice Address - Phone:402-917-2570
Practice Address - Fax:402-941-7018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-14
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty