Individual
JASON R CUSSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
12743 SLASH PASS, FORT WAYNE, IN 46818-0063
(260) 345-7990
Mailing address
12743 SLASH PASS, FORT WAYNE, IN 46818-0063
(260) 345-7990
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39002779A
IN
Other
Enumeration date
08/30/2013
Last updated
05/25/2024
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