Healthcare Provider Details

I. General information

NPI: 1205820735
Provider Name (Legal Business Name): DALE RICHARD LUSH LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MDOS SGO 2501 CAPEHART ROAD
OFFUTT A F B NE
68113-1712
US

IV. Provider business mailing address

16017 CEDAR CIR
OMAHA NE
68130-1748
US

V. Phone/Fax

Practice location:
  • Phone: 402-294-7411
  • Fax:
Mailing address:
  • Phone: 402-321-2340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: