Provider Demographics
NPI:1255536835
Name:LUSK, SCOTT D
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:D
Last Name:LUSK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SW 12TH ST
Mailing Address - Street 2:OCALA PSYCHIATRIC ASSOCIATES
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-4018
Mailing Address - Country:US
Mailing Address - Phone:352-629-4350
Mailing Address - Fax:352-629-3070
Practice Address - Street 1:2 SW 12TH ST
Practice Address - Street 2:OCALA PSYCHIATRIC ASSOCIATES
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-4018
Practice Address - Country:US
Practice Address - Phone:352-629-4350
Practice Address - Fax:352-629-3070
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health