Provider Demographics
NPI:1871337469
Name:RUSH, MICHAELA D (LBA, BCBA)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:D
Last Name:RUSH
Suffix:
Gender:F
Credentials:LBA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 RUTH AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTT CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63780-1500
Mailing Address - Country:US
Mailing Address - Phone:573-450-2292
Mailing Address - Fax:
Practice Address - Street 1:552 W JACKSON TRL
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-2625
Practice Address - Country:US
Practice Address - Phone:573-243-5552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021029028103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst