Provider Demographics
NPI:1245303783
Name:CUSICK, CHRISTOPHER WILLIAM (BS)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:WILLIAM
Last Name:CUSICK
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:791 PRICE ST
Mailing Address - Street 2:#135
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-2529
Mailing Address - Country:US
Mailing Address - Phone:805-305-5170
Mailing Address - Fax:805-805-5419
Practice Address - Street 1:2178 JOHNSON AVE
Practice Address - Street 2:SAN LUIS OBISPO COUNTY MENTAL HEALTH SERVICES
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4535
Practice Address - Country:US
Practice Address - Phone:805-541-5144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3793101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor