Provider Demographics
NPI:1114214533
Name:RUSHING, KATRINA RUSSHETTE (MMHC, LPC (US))
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:RUSSHETTE
Last Name:RUSHING
Suffix:
Gender:F
Credentials:MMHC, LPC (US)
Other - Prefix:MRS
Other - First Name:KATRINA
Other - Middle Name:RUSSHETTE
Other - Last Name:HOLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:312 NE 28TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-2821
Mailing Address - Country:US
Mailing Address - Phone:405-276-2496
Mailing Address - Fax:
Practice Address - Street 1:312 NE 28TH ST STE 109A
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-2822
Practice Address - Country:US
Practice Address - Phone:405-276-2496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103K00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200385520AMedicaid