Provider Demographics
NPI:1508849910
Name:RUSHWORTH, BETSY (PHD)
Entity Type:Individual
Prefix:DR
First Name:BETSY
Middle Name:
Last Name:RUSHWORTH
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 1:2217 BEECH DR
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-3510
Mailing Address - Country:US
Mailing Address - Phone:406-727-2143
Mailing Address - Fax:406-727-9101
Practice Address - Street 1:906 7TH ST S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4026
Practice Address - Country:US
Practice Address - Phone:406-727-2143
Practice Address - Fax:406-727-9101
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT498251Medicaid
MTM000005147Medicare PIN
5147Medicare ID - Type Unspecified