Provider Demographics
NPI:1528254968
Name:LUSTER, DENNIS J (LPC)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:J
Last Name:LUSTER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 N COUNTY RD E # F
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-9074
Mailing Address - Country:US
Mailing Address - Phone:608-758-8412
Mailing Address - Fax:
Practice Address - Street 1:3530 N COUNTY RD E # F
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-9074
Practice Address - Country:US
Practice Address - Phone:608-758-8412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2528-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39674500Medicaid