Provider Demographics
NPI:1629558002
Name:RUSH, BRITTANY DANIELLE
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:DANIELLE
Last Name:RUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:DANIELLE
Other - Last Name:CLINARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:736 OLD CELINA RD
Mailing Address - Street 2:
Mailing Address - City:ALLONS
Mailing Address - State:TN
Mailing Address - Zip Code:38541-6908
Mailing Address - Country:US
Mailing Address - Phone:931-823-6408
Mailing Address - Fax:
Practice Address - Street 1:1445 E 10TH ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2017
Practice Address - Country:US
Practice Address - Phone:800-423-2559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRBT-18-62876106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician