Provider Demographics
NPI:1972681369
Name:BECKY KUSICK, MA, LPC, INC
Entity Type:Organization
Organization Name:BECKY KUSICK, MA, LPC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSICK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:303-907-6499
Mailing Address - Street 1:PO BOX 511
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80038-0511
Mailing Address - Country:US
Mailing Address - Phone:303-907-6499
Mailing Address - Fax:855-812-8339
Practice Address - Street 1:80 GARDEN CTR STE 122
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-1735
Practice Address - Country:US
Practice Address - Phone:303-907-6499
Practice Address - Fax:855-812-8339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO799101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty