MEDICARE: LISA RUEHL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	101YM0800X	Mental Health Counselor	C10310	NV

General Provider Information

NPI Number	:	1063877983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA RUEHL

Provider Business Mailing Address
First Line	:	243 GREENBRIAR TOWNHOUSE WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-2462
Country	:	US
Telephone Number	:	702-572-7673
Fax Number	:

Provider Business Practice Location Address
First Line	:	243 GREENBRIAR TOWNHOUSE WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-2462
Country	:	US
Telephone Number	:	702-572-7673
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2015
Last Update Date	:	12/16/2024

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Directions to “ LISA RUEHL ” Practice Location

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