MEDICARE: STACY M RUSE LPCI, NCC, CYI

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	71941	TX

General Provider Information

NPI Number	:	1730571845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY M RUSE LPCI, NCC, CYI

Provider Business Mailing Address
First Line	:	825 DELAWARE AVE STE 206
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80501-6169
Country	:	US
Telephone Number	:	720-526-8102
Fax Number	:	817-412-7031

Provider Business Practice Location Address
First Line	:	825 DELAWARE AVE STE 206
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80501-6169
Country	:	US
Telephone Number	:	720-526-8102
Fax Number	:	817-412-7031

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

Provider Enumeration Date	:	02/26/2015
Last Update Date	:	09/17/2021

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