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General NPI Number Information
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NPI Number | 1154739670
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Entity Type | Individual
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Provider Name | MYRA J RUDY LMFT
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Gender | Female
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Dates
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Enumeration Date | 07/28/2014
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Last Update Date | 07/28/2014
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Provider Practice Location Address
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Address Line | 440 BOULDER CT STE 100B
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City | PLEASANTON
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State | CA
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Zip | 94566-8313
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Country | US
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Telephone | 925-699-2820
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Fax |
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Provider Business Mailing Address
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Address Line | 1807 SANTA RITA RD # D209
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City | PLEASANTON
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State | CA
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Zip | 94566-4779
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Country | US
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Telephone | 925-699-2820
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT52823
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License Number State | CA
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