MEDICARE: CARISSA JEAN RUBEN MA, MFTC

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	MFTC0013475	CO

General Provider Information

NPI Number	:	1659764637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARISSA JEAN RUBEN MA, MFTC

Provider Business Mailing Address
First Line	:	6330 FARTHING DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-7504
Country	:	US
Telephone Number	:	303-656-0813
Fax Number	:

Provider Business Practice Location Address
First Line	:	6330 FARTHING DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-7504
Country	:	US
Telephone Number	:	303-656-0813
Fax Number	:

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

Provider Enumeration Date	:	03/14/2015
Last Update Date	:	03/14/2015

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