MEDICARE: MS. RANDY RUTKIN MFT

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	106H00000X	Marriage & Family Therapist	1001	NV

General Provider Information

NPI Number	:	1306054846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RANDY RUTKIN MFT

Provider Business Mailing Address
First Line	:	2154 MAPLE HEIGHTS CT
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-8544
Country	:	US
Telephone Number	:	702-269-4719
Fax Number	:

Provider Business Practice Location Address
First Line	:	2154 MAPLE HEIGHTS CT
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-8544
Country	:	US
Telephone Number	:	702-269-4719
Fax Number	:

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

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	07/08/2007

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