Provider Demographics
NPI:1710230297
Name:CUSHION, LEE ANN
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:ANN
Last Name:CUSHION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:837 GLENHAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-3056
Mailing Address - Country:US
Mailing Address - Phone:517-775-4701
Mailing Address - Fax:
Practice Address - Street 1:837 GLENHAVEN AVE
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-3056
Practice Address - Country:US
Practice Address - Phone:517-775-4701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-20
Last Update Date:2012-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801033521101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health