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Individual

DESTINY D RUSH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
424 E SOUTHWAY BLVD, KOKOMO, IN 46902-3814
(765) 288-1928
Mailing address
240 N TILLOTSON AVE, MUNCIE, IN 47304-3988
(765) 288-1928

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
88001830A
IN

Other

Enumeration date
09/06/2022
Last updated
01/30/2023
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