Provider Demographics
NPI:1851120711
Name:RISKUS, MAHRA R
Entity type:Individual
Prefix:
First Name:MAHRA
Middle Name:R
Last Name:RISKUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N 1ST ST APT 27
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-2284
Mailing Address - Country:US
Mailing Address - Phone:814-243-5805
Mailing Address - Fax:
Practice Address - Street 1:339 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658-1131
Practice Address - Country:US
Practice Address - Phone:724-238-5696
Practice Address - Fax:724-238-7877
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health