Individual
LAURISA ROGERS LUSBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
413 ALLUMBAUGH ST, STE 102, BOISE, ID 83704-9212
(208) 287-0993
(208) 287-0996
Mailing address
2584 E BERGESON ST, BOISE, ID 83706-6014
(208) 921-3501
(208) 343-1371
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
26313
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L5916
BLUE CROSS
ID
Enumeration date
03/01/2007
Last updated
07/08/2007
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