Provider Demographics
NPI:1952768269
Name:RUSK, TECKY ANN (LPCC-S)
Entity type:Individual
Prefix:MRS
First Name:TECKY
Middle Name:ANN
Last Name:RUSK
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S MAIN ST STE 305
Mailing Address - Street 2:
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830-2361
Mailing Address - Country:US
Mailing Address - Phone:567-429-1000
Mailing Address - Fax:419-436-7460
Practice Address - Street 1:125 S MAIN ST STE 305
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-2361
Practice Address - Country:US
Practice Address - Phone:567-429-1000
Practice Address - Fax:419-436-7460
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1800504101YP2500X
OHE.1800504-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0258012Medicaid