Basic Information
| Provider Information | |||||||||
| NPI: | 1194996397 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUSCO | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | KAY | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | L.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 S BLISS AVENUE | ||||||||
| Address2: | CHEROKEE NATION BEHAVIORAL HEALTH | ||||||||
| City: | TAHLEQUAH | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184583170 | ||||||||
| FaxNumber: | 9184583610 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 S BLISS AVENUE | ||||||||
| Address2: | CHEROKEE NATION BEHAVIORAL HEALTH | ||||||||
| City: | TAHLEQUAH | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184583170 | ||||||||
| FaxNumber: | 9184583610 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2008 | ||||||||
| LastUpdateDate: | 03/14/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 2008 | OK | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.