Provider Demographics
NPI:1184657108
Name:PAUL RUST INC.
Entity Type:Organization
Organization Name:PAUL RUST INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:RUST
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LMFT
Authorized Official - Phone:479-484-1111
Mailing Address - Street 1:5111 ROGERS AVE.
Mailing Address - Street 2:SUITE 504
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903
Mailing Address - Country:US
Mailing Address - Phone:479-484-1111
Mailing Address - Fax:479-484-1111
Practice Address - Street 1:5111 ROGERS AVE.
Practice Address - Street 2:SUITE 504
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903
Practice Address - Country:US
Practice Address - Phone:479-484-1111
Practice Address - Fax:479-484-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC2371041C0700X
ARM9803014106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5G027OtherMEDICARE PTAN
AR5G027OtherMEDICARE PTAN