Healthcare Provider Details

I. General information

NPI: 1548900889
Provider Name (Legal Business Name): MARIAH RUYLE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 N LINN ST STE 2A
IOWA CITY IA
52245-2143
US

IV. Provider business mailing address

123 N LINN ST STE 2A
IOWA CITY IA
52245-2143
US

V. Phone/Fax

Practice location:
  • Phone: 319-337-3357
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number096073
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: