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General NPI Number Information
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NPI Number | 1942219753
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Entity Type | Individual
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Provider Name | SAMANTHA M RUTH MA LLP
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Gender | Female
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 735 S GARFIELD AVE STE 200
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City | TRAVERSE CITY
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State | MI
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Zip | 49686-3471
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Country | US
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Telephone | 248-730-5544
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Fax |
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Provider Business Mailing Address
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Address Line | 2632 CROSSING CIR # 1020
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-7930
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Country | US
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Telephone | 248-730-5544
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301010770
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License Number State | MI
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