Healthcare Provider Details

I. General information

NPI: 1205505385
Provider Name (Legal Business Name): RISHA E RUANO-ZIN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 YEAGER RD
WEST LAFAYETTE IN
47906-1578
US

IV. Provider business mailing address

1015 N 21ST ST
LAFAYETTE IN
47904-2216
US

V. Phone/Fax

Practice location:
  • Phone: 765-237-3326
  • Fax:
Mailing address:
  • Phone: 706-313-7318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39004011A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: