Basic Information
| Provider Information | |||||||||
| NPI: | 1598338105 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUSK | ||||||||
| FirstName: | JASIRAE | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10921 BOUDREAUX RD APT 7304 | ||||||||
| Address2: | |||||||||
| City: | TOMBALL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773755904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2819028222 | ||||||||
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| Practice Location | |||||||||
| Address1: | 233 SGT ED HOLCOMB BLVD S | ||||||||
| Address2: | |||||||||
| City: | CONROE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773041990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9365216100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2021 | ||||||||
| LastUpdateDate: | 07/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 83050 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.