Provider Demographics
NPI:1336805316
Name:RUSTIGE, JEFFREY JOSEPH (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:JOSEPH
Last Name:RUSTIGE
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10564 THOMAS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MO
Mailing Address - Zip Code:63631-9438
Mailing Address - Country:US
Mailing Address - Phone:573-315-6636
Mailing Address - Fax:
Practice Address - Street 1:103 STRAUSS DR
Practice Address - Street 2:
Practice Address - City:PARK HILLS
Practice Address - State:MO
Practice Address - Zip Code:63601-2400
Practice Address - Country:US
Practice Address - Phone:573-327-9841
Practice Address - Fax:573-327-9843
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-13
Last Update Date:2024-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024012651101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health