Provider Demographics
NPI:1386067528
Name:LONG, RUTH ANN (LPC-S)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ANN
Last Name:LONG
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 MARTIN DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-6247
Mailing Address - Country:US
Mailing Address - Phone:817-358-6997
Mailing Address - Fax:817-358-6980
Practice Address - Street 1:2217 MARTIN DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-6247
Practice Address - Country:US
Practice Address - Phone:817-358-6997
Practice Address - Fax:817-358-6980
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62237101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor