MEDICARE: LEE ANN CUSHION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	6801033521	MI

General Provider Information

NPI Number	:	1710230297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE ANN CUSHION

Provider Business Mailing Address
First Line	:	837 GLENHAVEN AVE
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-3056
Country	:	US
Telephone Number	:	517-775-4701
Fax Number	:

Provider Business Practice Location Address
First Line	:	837 GLENHAVEN AVE
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-3056
Country	:	US
Telephone Number	:	517-775-4701
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2012
Last Update Date	:	10/20/2012

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Directions to “ LEE ANN CUSHION ” Practice Location

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