Provider Demographics
NPI:1093845364
Name:RUTLEDGE, R.B. (CLINICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:R.B.
Middle Name:
Last Name:RUTLEDGE
Suffix:
Gender:M
Credentials:CLINICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6234 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-4320
Mailing Address - Country:US
Mailing Address - Phone:602-754-5046
Mailing Address - Fax:602-243-7291
Practice Address - Street 1:6234 S 11TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-4320
Practice Address - Country:US
Practice Address - Phone:602-754-5046
Practice Address - Fax:602-243-7291
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health