Provider Demographics
NPI:1306168844
Name:RUSK, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:RUSK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:994 N. MOSELEY RD
Mailing Address - Street 2:
Mailing Address - City:COLCORD
Mailing Address - State:OK
Mailing Address - Zip Code:74338
Mailing Address - Country:US
Mailing Address - Phone:918-723-3735
Mailing Address - Fax:918-723-3730
Practice Address - Street 1:747 HWY 59 #4
Practice Address - Street 2:
Practice Address - City:WESTVILLE
Practice Address - State:OK
Practice Address - Zip Code:74965
Practice Address - Country:US
Practice Address - Phone:918-723-3735
Practice Address - Fax:918-723-3730
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor