Provider Demographics
NPI:1689384224
Name:LUSCH, KASEY (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:LUSCH
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 W WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-2758
Mailing Address - Country:US
Mailing Address - Phone:734-707-7315
Mailing Address - Fax:
Practice Address - Street 1:28 W WILLOW ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-2758
Practice Address - Country:US
Practice Address - Phone:734-707-7315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401223296101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6401223296OtherLPC