Provider Demographics
NPI:1518504208
Name:RUSCO, AMANDA DAWN (MS LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:DAWN
Last Name:RUSCO
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20016 E 62ND PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80019-2208
Mailing Address - Country:US
Mailing Address - Phone:405-436-9275
Mailing Address - Fax:
Practice Address - Street 1:20016 E 62ND PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80019-2208
Practice Address - Country:US
Practice Address - Phone:405-436-9275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-02
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0018497101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional