Doctor Name: | ANDREA RUSE |
NPI Number: | 1093086142 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PLPC |
License Number: | 2012001549 |
Business Practice Address: | 8218 Pence Rd Pleasant Valley, MO - 640689586 |
Business Phone Number: | 8168984800 |
Business Fax Number: | |
Mailing Address: | 8218 Pence Rd, PLEASANT VALLEY |
State: | MO |
Postal Code: | 640689586 |
Phone Number: | 8168984800 |
Fax Number: | |
NPI Enumeration Date: | 01/21/2012 |
NPI Last Update Date: | 01/21/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 2012001549 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |