Healthcare Provider Details

I. General information

NPI: 1598855884
Provider Name (Legal Business Name): KIMBERLY SUE RUTH MS,CAC,LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 STORY RD
EXPORT PA
15632-2666
US

IV. Provider business mailing address

155 SKYLINE DR
CALIFORNIA PA
15419-1276
US

V. Phone/Fax

Practice location:
  • Phone: 724-468-3999
  • Fax: 724-468-0039
Mailing address:
  • Phone: 724-938-2783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC001402
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier116587
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerVBH OF PA PROVIDER NUMBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: