Provider Demographics
NPI:1437153426
Name:RUSAK, RONIKAYE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:RONIKAYE
Middle Name:
Last Name:RUSAK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 LAMAR AVE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-4479
Mailing Address - Country:US
Mailing Address - Phone:903-785-0400
Mailing Address - Fax:903-785-0403
Practice Address - Street 1:737 LAMAR AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-4479
Practice Address - Country:US
Practice Address - Phone:903-785-0400
Practice Address - Fax:903-785-0403
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16927101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7164LCOtherBLUE CROSS BLUE SHIELD
TX141895601Medicaid