Provider Demographics
NPI:1235182742
Name:GUSHURST, ROB (PHD)
Entity Type:Individual
Prefix:
First Name:ROB
Middle Name:
Last Name:GUSHURST
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:STEWART
Other - Last Name:GUSHURST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1011 CLEARVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-1919
Mailing Address - Country:US
Mailing Address - Phone:540-371-3940
Mailing Address - Fax:
Practice Address - Street 1:1011 CLEARVIEW AVE
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405-1919
Practice Address - Country:US
Practice Address - Phone:540-371-3940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2008-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000628103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA62638OtherUNITHE HEALTH CARE
VA62638OtherVALUE OPTIONS
VA0030590000OtherMAGELLAN
VA1553334OtherCIGNA HEALTH CARE
VA1051829OtherCIGNA BEH HEALTH
VA274305OtherANTHEM
VA6131524OtherUNITED BEH HEALTH
VA7755261Medicaid
R65526Medicare UPIN