Provider Demographics
NPI:1619433497
Name:RUSCA, LISA ROCHELLE (LMFT, LPCC, MPA)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ROCHELLE
Last Name:RUSCA
Suffix:
Gender:F
Credentials:LMFT, LPCC, MPA
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:ROCHELLE
Other - Last Name:DANIELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AMFT, APCC, MPA
Mailing Address - Street 1:703 E UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-6124
Mailing Address - Country:US
Mailing Address - Phone:559-974-5143
Mailing Address - Fax:
Practice Address - Street 1:5588 N PALM AVE STE Q5
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-1913
Practice Address - Country:US
Practice Address - Phone:559-777-5077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-16
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC12130101YP2500X
CALMFT129281106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1619433497OtherNPI
CA1619433497OtherNPI # - AMFT/APCC