Provider Demographics
NPI:1457794687
Name:LUSTH, THOMAS CHARLES (LCPC-C)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:CHARLES
Last Name:LUSTH
Suffix:
Gender:M
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 BIRCH POINT RD
Mailing Address - Street 2:
Mailing Address - City:WISCASSET
Mailing Address - State:ME
Mailing Address - Zip Code:04578-4900
Mailing Address - Country:US
Mailing Address - Phone:207-882-6594
Mailing Address - Fax:207-687-2233
Practice Address - Street 1:343 BIRCH POINT RD
Practice Address - Street 2:
Practice Address - City:WISCASSET
Practice Address - State:ME
Practice Address - Zip Code:04578-4900
Practice Address - Country:US
Practice Address - Phone:207-882-6594
Practice Address - Fax:207-687-2233
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4071101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor