Basic Information
| Provider Information | |||||||||
| NPI: | 1770542557 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUSH | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | L.C.S.W., L.M.F.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2829 4TH AVE | ||||||||
| Address2: | 150 | ||||||||
| City: | LAKE CHARLES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706017887 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3374777091 | ||||||||
| FaxNumber: | 3374744552 | ||||||||
| Practice Location | |||||||||
| Address1: | 2829 4TH AVE | ||||||||
| Address2: | 150 | ||||||||
| City: | LAKE CHARLES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706017887 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3374777091 | ||||||||
| FaxNumber: | 3374744552 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 2644 | LA | X | Behavioral Health & Social Service Providers | Social Worker | Clinical | 106H00000X | 360 | LA | X | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.