Provider Demographics
NPI:1255827960
Name:RUSH, CHEYANNE MICHELLE (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:CHEYANNE
Middle Name:MICHELLE
Last Name:RUSH
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2831 S HURSTBOURNE PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-4112
Mailing Address - Country:US
Mailing Address - Phone:502-915-8343
Mailing Address - Fax:
Practice Address - Street 1:2831 S HURSTBOURNE PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-4112
Practice Address - Country:US
Practice Address - Phone:502-915-8343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT1623345106S00000X
KY1-19-40279103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician