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General NPI Number Information
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NPI Number | 1780264101
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Entity Type | Individual
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Provider Name | BENJAMIN ALAN RUCKER LMHC
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Gender | Male
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Dates
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Enumeration Date | 04/09/2021
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 2624 N DIVISION ST # 1009
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City | SPOKANE
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State | WA
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Zip | 99207-2129
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Country | US
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Telephone | 612-799-5707
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Fax | 971-369-9478
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Provider Business Mailing Address
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Address Line | 2624 N DIVISION ST # 1009
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City | SPOKANE
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State | WA
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Zip | 99207-2129
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Country | US
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Telephone | 612-799-5707
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Fax | 971-369-9478
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH61531529
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License Number State | WA
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