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General NPI Number Information
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NPI Number | 1245303783
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Entity Type | Individual
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Provider Name | CHRISTOPHER WILLIAM CUSICK B.S.
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Gender | Male
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 02/20/2009
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Provider Practice Location Address
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Address Line | 2178 JOHNSON AVE SAN LUIS OBISPO COUNTY MENTAL HEALTH SERVICES
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-4535
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Country | US
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Telephone | 805-541-5144
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Fax |
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Provider Business Mailing Address
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Address Line | 791 PRICE ST #135
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City | PISMO BEACH
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State | CA
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Zip | 93449-2529
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Country | US
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Telephone | 805-305-5170
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Fax | 805-805-5419
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 3793
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License Number State | CA
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