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NPI Code Detail

MEDICARE: MS. VANISE LUSH B.A.

MEDICARE: MS. VANISE LUSH B.A.
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
1101Y00000XCounselor
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1174027825
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. VANISE LUSH B.A.
Provider Business Mailing Address
First Line : 124 KIMBROUGH BLVD BLDG Q
Second Line :
City : TALLULAH
State : LA
Zip : 71282-4307
Country : US
Telephone Number : 318-574-4400
Fax Number : 318-574-4407
Provider Business Practice Location Address
First Line : 124 KIMBROUGH BLVD BLDG Q
Second Line :
City : TALLULAH
State : LA
Zip : 71282-4307
Country : US
Telephone Number : 318-574-4400
Fax Number : 318-574-4407
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2018
Last Update Date : 11/30/2018

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