Healthcare Provider Details

I. General information

NPI: 1497661920
Provider Name (Legal Business Name): MATT RUEDA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 W LAKE LANSING RD APT 3027
EAST LANSING MI
48823-1397
US

IV. Provider business mailing address

2575 ABBOTT RD APT 3027
EAST LANSING MI
48823-8510
US

V. Phone/Fax

Practice location:
  • Phone: 518-335-8321
  • Fax:
Mailing address:
  • Phone: 518-335-8321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: