Provider Demographics
NPI:1023248390
Name:RUSHBROOK, JOHN C (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:RUSHBROOK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:809 CENTER STREET
Mailing Address - Street 2:SUITE 8A
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906
Mailing Address - Country:US
Mailing Address - Phone:517-853-1925
Mailing Address - Fax:517-853-1926
Practice Address - Street 1:809 CENTER STREET
Practice Address - Street 2:SUITE 8A
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-5257
Practice Address - Country:US
Practice Address - Phone:517-364-5130
Practice Address - Fax:517-364-5133
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI6301005413103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
N11130004(PTAN)Medicare UPIN