Provider Demographics
NPI:1124845052
Name:RUTHERFORD, ALLYIAH
Entity type:Individual
Prefix:
First Name:ALLYIAH
Middle Name:
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 396
Mailing Address - Street 2:
Mailing Address - City:HARTSHORNE
Mailing Address - State:OK
Mailing Address - Zip Code:74547-0396
Mailing Address - Country:US
Mailing Address - Phone:918-297-3400
Mailing Address - Fax:918-297-3401
Practice Address - Street 1:310 S 11TH ST
Practice Address - Street 2:
Practice Address - City:HARTSHORNE
Practice Address - State:OK
Practice Address - Zip Code:74547-4218
Practice Address - Country:US
Practice Address - Phone:918-297-3400
Practice Address - Fax:918-297-3401
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty