Provider Demographics
NPI:1538830781
Name:RUSH, TIMOTHY ERIN (LCPC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ERIN
Last Name:RUSH
Suffix:
Gender:M
Credentials:LCPC
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 67214
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66667-0214
Mailing Address - Country:US
Mailing Address - Phone:785-224-1861
Mailing Address - Fax:
Practice Address - Street 1:1100 SW WANAMAKER RD STE 2
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-3805
Practice Address - Country:US
Practice Address - Phone:785-224-1861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03768101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional