MEDICARE: ELVIRA RUSAK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	7678	TX

General Provider Information

NPI Number	:	1104416015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELVIRA RUSAK

Provider Business Mailing Address
First Line	:	8821 DAVIS BLVD STE 100
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-0329
Country	:	US
Telephone Number	:	855-444-5664
Fax Number	:

Provider Business Practice Location Address
First Line	:	8821 DAVIS BLVD STE 100
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-0329
Country	:	US
Telephone Number	:	855-444-5664
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2021
Last Update Date	:	03/18/2026

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Directions to “ ELVIRA RUSAK ” Practice Location

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