Provider Demographics
NPI:1366593063
Name:ROUSH, DAVID HENRY (PSYD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:HENRY
Last Name:ROUSH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2378 NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-2009
Mailing Address - Country:US
Mailing Address - Phone:937-879-7996
Mailing Address - Fax:937-879-7959
Practice Address - Street 1:2378 NATIONAL RD
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-2009
Practice Address - Country:US
Practice Address - Phone:937-879-7996
Practice Address - Fax:937-879-7959
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5807103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
346766000OtherAETNA
OH2267765Medicaid
364903OtherTRICARE
P12035861OtherMULTIPLAN
000000239252OtherANTHEM
346766000OtherMAGELLAN BEHAVIORAL HEALT
476759OtherVALUE OPTIONS
346766000OtherCIGNA
OH2267765Medicaid