MEDICARE: RUIZ PSYCHOLOGICAL SERVICES INC.

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	251S00000X	Community/Behavioral Health Agency	180.009660	IL

General Provider Information

NPI Number	:	1386181394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUIZ PSYCHOLOGICAL SERVICES INC.

Provider Business Mailing Address
First Line	:	701 PIPER LN
Second Line	:
City	:	PROSPECT HEIGHTS
State	:	IL
Zip	:	60070-3613
Country	:	US
Telephone Number	:	847-636-9836
Fax Number	:

Provider Business Practice Location Address
First Line	:	6232 N PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-5132
Country	:	US
Telephone Number	:	312-451-6157
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	DIANA RUIZ
Credential	:	M.A, LCPC
Telephone Number	:	847-636-9836

Provider Enumeration Date	:	01/28/2017
Last Update Date	:	01/28/2017

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