Healthcare Provider Details

I. General information

NPI: 1730375619
Provider Name (Legal Business Name): NATALIE O RUGE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7545 CENTURION PKWY STE 104
JACKSONVILLE FL
32256-4118
US

IV. Provider business mailing address

7545 CENTURION PKWY STE 104
JACKSONVILLE FL
32256-4118
US

V. Phone/Fax

Practice location:
  • Phone: 904-651-5102
  • Fax: 773-897-1726
Mailing address:
  • Phone: 904-651-5102
  • Fax: 773-897-1726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT2419
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF 51455
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: