Provider Demographics
NPI:1386045151
Name:LUSK, MARCY (PSYD)
Entity type:Individual
Prefix:MRS
First Name:MARCY
Middle Name:
Last Name:LUSK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8421 MORNINGDEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-9642
Mailing Address - Country:US
Mailing Address - Phone:714-696-2485
Mailing Address - Fax:
Practice Address - Street 1:8421 MORNINGDEW DRIVE
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-9642
Practice Address - Country:US
Practice Address - Phone:614-683-5809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2023-07-22
Deactivation Date:2023-06-15
Deactivation Code:
Reactivation Date:2023-07-20
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 390200000X
OHP08098103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program