Provider Demographics
NPI:1194276030
Name:RUIZ, SANJUANITA (MS, LPC)
Entity type:Individual
Prefix:
First Name:SANJUANITA
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 UMAR AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-5960
Mailing Address - Country:US
Mailing Address - Phone:956-605-2400
Mailing Address - Fax:
Practice Address - Street 1:600 E GRIFFIN PKWY STE B
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572
Practice Address - Country:US
Practice Address - Phone:956-600-7123
Practice Address - Fax:956-600-7101
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-15
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75654101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional