Healthcare Provider Details

I. General information

NPI: 1790607356
Provider Name (Legal Business Name): JOSHUA RUIZ
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 DICKSON DR STE 14
AUSTIN TX
78704-4788
US

IV. Provider business mailing address

2028 E BEN WHITE BLVD # 240-2595
AUSTIN TX
78741-6966
US

V. Phone/Fax

Practice location:
  • Phone: 512-487-0967
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number101473
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: