Healthcare Provider Details

I. General information

NPI: 1326873084
Provider Name (Legal Business Name): SUSAN MARIE RUGARI LMFT ASSOCIATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27630 S US HIGHWAY 281
HICO TX
76457-2394
US

IV. Provider business mailing address

27630 S US HIGHWAY 281
HICO TX
76457-2394
US

V. Phone/Fax

Practice location:
  • Phone: 817-247-1192
  • Fax:
Mailing address:
  • Phone: 817-247-1192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number204152
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: