Provider Demographics
NPI:1013926799
Name:RASMUSSEN, RUSS A (PSY D)
Entity Type:Individual
Prefix:DR
First Name:RUSS
Middle Name:A
Last Name:RASMUSSEN
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:742 RAMBLIN RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-8351
Mailing Address - Country:US
Mailing Address - Phone:317-881-9476
Mailing Address - Fax:317-889-5912
Practice Address - Street 1:1701 LIBRARY BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1567
Practice Address - Country:US
Practice Address - Phone:317-889-5612
Practice Address - Fax:317-889-5912
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040529103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical