Healthcare Provider Details

I. General information

NPI: 1679704464
Provider Name (Legal Business Name): DIAN CUELLAR RUUD PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2009
Last Update Date: 07/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 S 1ST ST
TEMPLE TX
76504-7451
US

IV. Provider business mailing address

901 HARTRICK CANYON DR
TEMPLE TX
76502-4233
US

V. Phone/Fax

Practice location:
  • Phone: 254-743-0315
  • Fax:
Mailing address:
  • Phone: 254-982-4284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number03951
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: