Provider Demographics
NPI:1386993939
Name:RUIZ, CARLOS (MDIV, MA INTERN)
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:
Last Name:RUIZ
Suffix:
Gender:M
Credentials:MDIV, MA INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 A. THORNHILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2703
Mailing Address - Country:US
Mailing Address - Phone:630-752-9750
Mailing Address - Fax:
Practice Address - Street 1:507 A. THORNHILL DRIVE
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2703
Practice Address - Country:US
Practice Address - Phone:630-752-9750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral