Individual
JUSTIN LEE RUZICKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHP, PLADC
Contact information
Practice address
116 TERRY BLVD, GERING, NE 69341-1601
(308) 632-3981
Mailing address
116 TERRY BLVD, GERING, NE 69341-1601
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
P-1869
NE
101YM0800X
Mental Health Counselor
Primary
12631
NE
Other
Enumeration date
06/22/2021
Last updated
06/22/2021
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