Healthcare Provider Details

I. General information

NPI: 1265740054
Provider Name (Legal Business Name): CRYSTAL RUSK LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL SUETHOLZ LPCC

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 E FREEDOM WAY UNIT 302
CINCINNATI OH
45202-3480
US

IV. Provider business mailing address

121 E FREEDOM WAY UNIT 302
CINCINNATI OH
45202-3480
US

V. Phone/Fax

Practice location:
  • Phone: 859-609-4454
  • Fax:
Mailing address:
  • Phone: 859-609-4454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number174800
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC6925
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.1000088
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC7434
License Number StateOR
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number174800
License Number StateKY
# 6
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.1000088
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC7434
License Number StateOR
# 8
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC6925
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: