Healthcare Provider Details

I. General information

NPI: 1679708200
Provider Name (Legal Business Name): PHIL RUTTENBURG MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 05/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 EAST AVE
CHICO CA
95926-1609
US

IV. Provider business mailing address

6 MORAGA DR
CHICO CA
95926-1426
US

V. Phone/Fax

Practice location:
  • Phone: 530-891-3050
  • Fax:
Mailing address:
  • Phone: 530-895-3245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC30465
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: