Healthcare Provider Details

I. General information

NPI: 1922278779
Provider Name (Legal Business Name): MARK E RUCH LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FAITH ACADEMY, PENNY LANE, VALLEY GOLF SUBD. DON CELSO TUAZON AVENUE
CAINTA RIZAL
1900
PH

IV. Provider business mailing address

SIL - P.O. BOX 2270
MANILA PHILIPPINES
1099
PH

V. Phone/Fax

Practice location:
  • Phone: 6580048
  • Fax: 6580026
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4948
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: