Provider Demographics
NPI:1417288804
Name:RUSHING, ROD EUGENE (CAC II)
Entity Type:Individual
Prefix:
First Name:ROD
Middle Name:EUGENE
Last Name:RUSHING
Suffix:
Gender:M
Credentials:CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 S 21ST ST LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-3708
Mailing Address - Country:US
Mailing Address - Phone:800-604-8978
Mailing Address - Fax:
Practice Address - Street 1:1102 S 21ST ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-3708
Practice Address - Country:US
Practice Address - Phone:303-436-4727
Practice Address - Fax:303-436-4779
Is Sole Proprietor?:No
Enumeration Date:2010-01-25
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC.0006985101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1417288804Medicaid