Provider Demographics
NPI:1295236016
Name:LC PSYCHOTHERAPY SERVICES, LLC
Entity type:Organization
Organization Name:LC PSYCHOTHERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LUANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUSIC
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:302-388-2979
Mailing Address - Street 1:147 AVALINI WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34275-4034
Mailing Address - Country:US
Mailing Address - Phone:302-388-2979
Mailing Address - Fax:
Practice Address - Street 1:405 JULIA PL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-6915
Practice Address - Country:US
Practice Address - Phone:302-388-2979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-27
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13999101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty