Provider Demographics
NPI:1649989914
Name:LUSS, CHAYA
Entity type:Individual
Prefix:
First Name:CHAYA
Middle Name:
Last Name:LUSS
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 1:2921 INGLEWOOD AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4113
Mailing Address - Country:US
Mailing Address - Phone:763-352-1323
Mailing Address - Fax:
Practice Address - Street 1:2921 INGLEWOOD AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-4113
Practice Address - Country:US
Practice Address - Phone:763-352-1323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-16
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00479100101YM0800X
MN02743101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health