=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154897114
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANDRUSKI FAMILY COUNSELING INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2018
-----------------------------------------------------
Last Update Date | 12/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17130 SEQUOIA ST STE 103
-----------------------------------------------------
City | HESPERIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92345-1827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-403-3845
-----------------------------------------------------
Fax | 442-267-5241
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 291881
-----------------------------------------------------
City | PHELAN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92329-1881
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-403-3845
-----------------------------------------------------
Fax | 442-267-5241
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | KASEY ANDRUSKI
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 760-403-3845
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------