Provider Demographics
NPI:1760568026
Name:RUSH, NANCY ANN II (MA,LCSW,LPC,ALPS)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ANN
Last Name:RUSH
Suffix:II
Gender:F
Credentials:MA,LCSW,LPC,ALPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1748
Mailing Address - Country:US
Mailing Address - Phone:304-842-8852
Mailing Address - Fax:304-842-8853
Practice Address - Street 1:243 W MAIN ST
Practice Address - Street 2:PROGRESSIVE PREVENTIVE HEALTH CARE
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1748
Practice Address - Country:US
Practice Address - Phone:304-842-8852
Practice Address - Fax:304-842-8853
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVCP00453683/513101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVPR9356071Medicare ID - Type Unspecified