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General NPI Number Information
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NPI Number | 1912590993
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Entity Type | Organization
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Legal Business Name | RUSTON THERAPY PLLC
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Dates
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Enumeration Date | 02/19/2021
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Last Update Date | 08/27/2024
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Provider Practice Location Address
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Address Line | 4501 15TH AVE S STE 102
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City | SEATTLE
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State | WA
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Zip | 98108-1874
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Country | US
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Telephone | 206-335-7005
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Fax | 206-267-0668
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Provider Business Mailing Address
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Address Line | 4501 15TH AVE S STE 102
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City | SEATTLE
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State | WA
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Zip | 98108-1874
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Country | US
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Telephone | 206-335-7005
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Fax | 206-267-0668
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | NICOLE RUSTON
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Credential | MS, LMHC
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Telephone | 206-335-7005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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