Healthcare Provider Details

I. General information

NPI: 1285178780
Provider Name (Legal Business Name): KELLY RUFF AMFT, APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10474 MATHER BLVD
MATHER CA
95655-4116
US

IV. Provider business mailing address

320 ARNOLD GAMBLE CIR
SACRAMENTO CA
95835-1709
US

V. Phone/Fax

Practice location:
  • Phone: 916-228-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14160
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number140303
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: