Individual
MRS. THERESA LYNN RUST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PCC-S, LSW, LICDC-CS
Contact information
Practice address
80 HIGHWAY 2227, SOMERSET, KY 42503-1562
(513) 475-2702
Mailing address
80 HIGHWAY 2227, SOMERSET, KY 42503-1562
(513) 475-2702
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
981323
OH
101YM0800X
Mental Health Counselor
Primary
240672
KY
101YM0800X
Mental Health Counselor
E 0004070 SUPV
OH
101YP2500X
Professional Counselor
240672
KY
104100000X
Social Worker
S 0019424
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0279638
—
OH
05
—
7100731970
—
KY
Enumeration date
06/25/2015
Last updated
11/21/2024
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