Provider Demographics
NPI:1518328053
Name:ANDRUSKI, KASEY (LMFT)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:ANDRUSKI
Suffix:
Gender:F
Credentials:LMFT
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 291881
Mailing Address - Street 2:
Mailing Address - City:PHELAN
Mailing Address - State:CA
Mailing Address - Zip Code:92329-1881
Mailing Address - Country:US
Mailing Address - Phone:760-403-3845
Mailing Address - Fax:
Practice Address - Street 1:17130 SEQUOIA ST STE 103
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-1827
Practice Address - Country:US
Practice Address - Phone:760-403-3845
Practice Address - Fax:442-267-5241
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-11
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98928106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist