Provider Demographics
NPI:1386030468
Name:KUSICK, REBECCA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:KUSICK
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 511
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80038-0511
Mailing Address - Country:US
Mailing Address - Phone:303-907-6499
Mailing Address - Fax:855-812-8339
Practice Address - Street 1:80 GARDEN CTR STE 122
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-1735
Practice Address - Country:US
Practice Address - Phone:303-907-6499
Practice Address - Fax:855-812-8339
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO799101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health