Provider Demographics
NPI:1588717888
Name:CRUIKSHANKS, DANIEL RUSH (PHD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:RUSH
Last Name:CRUIKSHANKS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1195
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-7195
Mailing Address - Country:US
Mailing Address - Phone:866-936-8559
Mailing Address - Fax:866-936-8559
Practice Address - Street 1:120 S WASHINGTON ST
Practice Address - Street 2:SUITE 209
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-2840
Practice Address - Country:US
Practice Address - Phone:866-936-8559
Practice Address - Fax:866-936-8559
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0003431-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health