Healthcare Provider Details

I. General information

NPI: 1528028529
Provider Name (Legal Business Name): RUTH J. COHEN M.A., L.M.F.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16804 W PALISADE TRAIL LN # 12
SURPRISE AZ
85387-7229
US

IV. Provider business mailing address

19920 N CANYON WHISPER DR
SURPRISE AZ
85387-7269
US

V. Phone/Fax

Practice location:
  • Phone: 623-337-3388
  • Fax: 623-298-2068
Mailing address:
  • Phone: 623-337-3388
  • Fax: 623-322-1938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT-32424
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number358988
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number10219
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: