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General NPI Number Information
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NPI Number | 1770203416
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Entity Type | Individual
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Provider Name | RUBEN ANTONIO PRADO MS, LLMFT
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Gender | Male
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Dates
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Enumeration Date | 09/01/2022
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Last Update Date | 09/01/2022
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Provider Practice Location Address
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Address Line | 2350 GREEN RD STE 160
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City | ANN ARBOR
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State | MI
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Zip | 48105-1572
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Country | US
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Telephone | 315-771-4657
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Fax |
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Provider Business Mailing Address
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Address Line | 1120 WASHTENAW RD
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City | YPSILANTI
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State | MI
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Zip | 48197-2126
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Country | US
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Telephone | 315-771-4657
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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 | 4151001066
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License Number State | MI
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