Provider Demographics
NPI:1326588906
Name:RUSHING, ERVAN CLAY
Entity Type:Individual
Prefix:MR
First Name:ERVAN
Middle Name:CLAY
Last Name:RUSHING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ERVAN
Other - Middle Name:CLAY
Other - Last Name:RUSHING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3309 SIMMONS DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-1865
Mailing Address - Country:US
Mailing Address - Phone:405-905-2890
Mailing Address - Fax:
Practice Address - Street 1:3309 SIMMONS DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-1865
Practice Address - Country:US
Practice Address - Phone:405-905-2890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor