Provider Demographics
NPI:1861662959
Name:RUSH, COURTNEY LEE (MFT)
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:LEE
Last Name:RUSH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5628 SAN JOSE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-5913
Mailing Address - Country:US
Mailing Address - Phone:415-264-7493
Mailing Address - Fax:
Practice Address - Street 1:2300 M L K JR WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1412
Practice Address - Country:US
Practice Address - Phone:510-644-7310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51237106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist