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General NPI Number Information
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NPI Number | 1912538547
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Entity Type | Individual
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Provider Name | RUTHIE LEE STARK - REDMAN LCDC
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Gender | Female
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Dates
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Enumeration Date | 02/02/2020
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Last Update Date | 07/24/2022
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Provider Practice Location Address
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Address Line | 1100 NASA PWKY SUITE 201 A
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City | HOUSTON
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State | TX
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Zip | 77598-7759
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Country | US
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Telephone | 281-904-6512
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Fax |
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Provider Business Mailing Address
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Address Line | 9001 GLACIER AVE APT 226
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City | TEXAS CITY
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State | TX
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Zip | 77591-3017
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Country | US
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Telephone | 440-231-7096
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 14743
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License Number State | TX
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