Provider Demographics
NPI:1528467768
Name:RUSNAK, KARI (MA,LPC)
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:
Last Name:RUSNAK
Suffix:
Gender:F
Credentials:MA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 SPRING ST STE B
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-3423
Mailing Address - Country:US
Mailing Address - Phone:769-926-0308
Mailing Address - Fax:
Practice Address - Street 1:1285 SPRING ST STE B
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-3423
Practice Address - Country:US
Practice Address - Phone:769-926-0308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1921101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional