Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 6301005413 | MI |
NPI | 1023248390 |
---|---|
Provider Name | Dr. John C Rushbrook |
First Address | Lansing, MI 48906 |
Second Address | Lansing, MI 48906-5257 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2009 |
Last Update Date | 01/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
N11130004(PTAN) | (02) |