Provider Demographics
NPI:1487979639
Name:MENA-TELLEZ, RUTH NOHEMI (MSW PCSW-606)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:NOHEMI
Last Name:MENA-TELLEZ
Suffix:
Gender:F
Credentials:MSW PCSW-606
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 W YELLOWSTONE HWY
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-7507
Mailing Address - Country:US
Mailing Address - Phone:307-233-4276
Mailing Address - Fax:307-473-2650
Practice Address - Street 1:535 W. YELLOWSTONE HWY
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1336
Practice Address - Country:US
Practice Address - Phone:307-233-4276
Practice Address - Fax:307-473-2650
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPCSW-606101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health