Healthcare Provider Details

I. General information

NPI: 1114228004
Provider Name (Legal Business Name): J F RUPERT DSC, PHD, DD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 STATE ROUTE 327
JACKSON OH
45640-9282
US

IV. Provider business mailing address

PO BOX 28
JACKSON OH
45640-0028
US

V. Phone/Fax

Practice location:
  • Phone: 740-978-0676
  • Fax:
Mailing address:
  • Phone: 740-978-0676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: