Provider Demographics
NPI:1285102467
Name:RUIZ, PEDRO (LPC, LBSW, LCDC)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:
Last Name:RUIZ
Suffix:
Gender:M
Credentials:LPC, LBSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 BONHAM ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-5566
Mailing Address - Country:US
Mailing Address - Phone:432-296-2300
Mailing Address - Fax:
Practice Address - Street 1:219 S MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-2518
Practice Address - Country:US
Practice Address - Phone:432-250-1880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-06
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80281101YP2500X
TX31461104100000X
TX13875101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker