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General NPI Number Information
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NPI Number | 1699217364
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Entity Type | Organization
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Legal Business Name | COUNSELING AND PSYCHOLOGICAL SERVICES OF THE UPSTATE
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Dates
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Enumeration Date | 11/13/2016
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Last Update Date | 11/14/2016
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Provider Practice Location Address
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Address Line | 224 HOLLY AVE
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City | CLEMSON
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State | SC
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Zip | 29631-2347
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Country | US
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Telephone | 864-633-0210
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Fax | 864-722-5380
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Provider Business Mailing Address
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Address Line | 224 HOLLY AVE
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City | CLEMSON
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State | SC
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Zip | 29631-2347
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Country | US
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Telephone | 864-633-0210
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Fax | 864-722-5380
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | CHRISTOPHER RUTH
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Credential | PHD
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Telephone | 864-633-0210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 1323
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License Number State | SC
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