Provider Demographics
NPI:1366771529
Name:WILCOX, RUTH ELLEN (LMFT)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ELLEN
Last Name:WILCOX
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:ELLEN
Other - Last Name:DUSENBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:2169 SWANSON AVE.
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403
Mailing Address - Country:US
Mailing Address - Phone:928-412-5878
Mailing Address - Fax:
Practice Address - Street 1:2169 SWANSON AVE.
Practice Address - Street 2:SUITE 6
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403
Practice Address - Country:US
Practice Address - Phone:928-412-5878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-17
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45364106H00000X
AZLMFT15555106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist