Provider Demographics
NPI:1891960217
Name:AUSMUS, NEALA (LCPC,RD)
Entity Type:Individual
Prefix:
First Name:NEALA
Middle Name:
Last Name:AUSMUS
Suffix:
Gender:F
Credentials:LCPC,RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 PROFESSIONAL DR STE A
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-5943
Mailing Address - Country:US
Mailing Address - Phone:217-793-9593
Mailing Address - Fax:217-793-6949
Practice Address - Street 1:3000 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-5931
Practice Address - Country:US
Practice Address - Phone:217-793-9593
Practice Address - Fax:217-793-6949
Is Sole Proprietor?:No
Enumeration Date:2008-04-27
Last Update Date:2008-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005285101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor