Provider Demographics
NPI:1619248416
Name:LUSK, KARRI ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KARRI
Middle Name:ANN
Last Name:LUSK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KARRI
Other - Middle Name:
Other - Last Name:ZUMWALT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:255 E SONTERRA BLVD STE 119
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4075
Mailing Address - Country:US
Mailing Address - Phone:210-447-6363
Mailing Address - Fax:210-447-6364
Practice Address - Street 1:255 E SONTERRA BLVD STE 119
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4075
Practice Address - Country:US
Practice Address - Phone:210-447-6363
Practice Address - Fax:210-447-6364
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34702103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX351455602Medicaid