Provider Demographics
NPI:1447754148
Name:LUSK, DEZAREE' LA' DESTINY (LCSW)
Entity Type:Individual
Prefix:
First Name:DEZAREE'
Middle Name:LA' DESTINY
Last Name:LUSK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 MACAW WAY
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-7210
Mailing Address - Country:US
Mailing Address - Phone:469-499-6200
Mailing Address - Fax:
Practice Address - Street 1:8950 WESTPARK DR STE 118
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-5502
Practice Address - Country:US
Practice Address - Phone:469-499-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2021-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX625941041C0700X
TX14495351744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management