Healthcare Provider Details

I. General information

NPI: 1922194356
Provider Name (Legal Business Name): SUSAN RUCKER LCMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USAHC HANAU UNIT 20193, BOX 0030
APO AE
09165-0030
US

IV. Provider business mailing address

CMR 470, BOX 4539
APO AE
09165
US

V. Phone/Fax

Practice location:
  • Phone: 496181889278
  • Fax: 496181888584
Mailing address:
  • Phone: 496181889278
  • Fax: 496181888584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLCM 159
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: