Provider Demographics
NPI:1407525579
Name:RUTHERFORD, SOPHIA PAZ- (MS, T-LMHC)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:PAZ-
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:MS, T-LMHC
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:
Other - Last Name:PAZ- RUTHERFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, T-LMHC
Mailing Address - Street 1:2951 KADING RD
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:IA
Mailing Address - Zip Code:50220-2391
Mailing Address - Country:US
Mailing Address - Phone:520-465-8903
Mailing Address - Fax:
Practice Address - Street 1:1251 334TH ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:IA
Practice Address - Zip Code:50276-7509
Practice Address - Country:US
Practice Address - Phone:515-438-3481
Practice Address - Fax:515-438-3489
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA107903101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health