Provider Demographics
NPI:1356309801
Name:ROUSH, DONA (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONA
Middle Name:
Last Name:ROUSH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13301 N MERIDIAN AVE
Mailing Address - Street 2:BLDG 100
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-9369
Mailing Address - Country:US
Mailing Address - Phone:405-752-9500
Mailing Address - Fax:405-752-9571
Practice Address - Street 1:13301 N MERIDIAN AVE
Practice Address - Street 2:BLDG 100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-9369
Practice Address - Country:US
Practice Address - Phone:405-752-9500
Practice Address - Fax:405-752-9571
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK744106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK7866131OtherAETNA
OK23727800173120A022OtherTRICARE