Provider Demographics
NPI:1548937717
Name:RAUSCH, ROSS JOHN (PLMHP)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:JOHN
Last Name:RAUSCH
Suffix:
Gender:M
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6540 TANGLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-2356
Mailing Address - Country:US
Mailing Address - Phone:402-202-8940
Mailing Address - Fax:
Practice Address - Street 1:6601 PIONEERS BLVD STE 1
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5260
Practice Address - Country:US
Practice Address - Phone:402-434-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12727101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health