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General NPI Number Information
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NPI Number | 1265544126
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Entity Type | Organization
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Legal Business Name | L E RUCKSTUHL INC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 02/11/2009
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Provider Practice Location Address
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Address Line | 5421 KIETZKE LN SUITE 202
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City | RENO
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State | NV
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Zip | 89511-1088
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Country | US
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Telephone | 775-787-7028
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Fax | 877-738-0730
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Provider Business Mailing Address
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Address Line | 5421 KIETZKE LANE SUITE 202
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City | RENO
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State | NV
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Zip | 89511-1088
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Country | US
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Telephone | 775-787-7028
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Fax | 877-738-0730
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LIONEL EDWARD RUCKSTUHL JR.
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Credential | PH.D.
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Telephone | 775-787-7028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY0462
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License Number State | NV
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