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General NPI Number Information
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NPI Number | 1356807176
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Entity Type | Individual
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Provider Name | SUNNY ELLEN LUSK MA, LPA INDEPENDENT
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Gender | Female
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Dates
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Enumeration Date | 02/17/2019
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Last Update Date | 02/17/2019
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Provider Practice Location Address
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Address Line | 9200 PINECROFT DR STE 250
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City | SHENANDOAH
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State | TX
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Zip | 77380-3286
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Country | US
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Telephone | 281-419-8400
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Fax | 281-292-1972
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Provider Business Mailing Address
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Address Line | 611 GLEN HAVEN DR
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City | CONROE
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State | TX
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Zip | 77385-7712
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Country | US
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Telephone | 281-210-4119
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 36448
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License Number State | TX
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