Provider Demographics
NPI:1093086142
Name:RUSE, ANDREA (PLPC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:RUSE
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8218 PENCE RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-9586
Mailing Address - Country:US
Mailing Address - Phone:816-898-4800
Mailing Address - Fax:
Practice Address - Street 1:8218 PENCE RD
Practice Address - Street 2:
Practice Address - City:PLEASANT VALLEY
Practice Address - State:MO
Practice Address - Zip Code:64068-9586
Practice Address - Country:US
Practice Address - Phone:816-898-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-21
Last Update Date:2012-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012001549101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional