Provider Demographics
NPI:1104441880
Name:RUBY, JAMES R (LMHC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:RUBY
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 W FERN DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-1014
Mailing Address - Country:US
Mailing Address - Phone:951-240-0960
Mailing Address - Fax:
Practice Address - Street 1:819 W FERN DR
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1014
Practice Address - Country:US
Practice Address - Phone:951-240-0960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMHC-367101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIMHC-367OtherSTATE OF HAWAII