Provider Demographics
NPI:1245825363
Name:LUSE, CORA ANNE
Entity type:Individual
Prefix:
First Name:CORA
Middle Name:ANNE
Last Name:LUSE
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 1:74 CARTER 105
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:MO
Mailing Address - Zip Code:63965-7024
Mailing Address - Country:US
Mailing Address - Phone:573-870-0315
Mailing Address - Fax:
Practice Address - Street 1:74 CARTER 105
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:MO
Practice Address - Zip Code:63965-7024
Practice Address - Country:US
Practice Address - Phone:573-870-0315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health