MEDICARE: MS. COURTNEY LEE RUSH MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	51237	CA

General Provider Information

NPI Number	:	1861662959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. COURTNEY LEE RUSH MFT

Provider Business Mailing Address
First Line	:	5628 SAN JOSE AVE
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94804-5913
Country	:	US
Telephone Number	:	415-264-7493
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 M L K JR WAY
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94704-1412
Country	:	US
Telephone Number	:	510-644-7310
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2008
Last Update Date	:	06/29/2016

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