Provider Demographics
NPI:1699117069
Name:RUGGLES, TED R (PHD)
Entity type:Individual
Prefix:DR
First Name:TED
Middle Name:R
Last Name:RUGGLES
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:1520 GASQUET FLAT
Mailing Address - City:GASQUET
Mailing Address - State:CA
Mailing Address - Zip Code:95543-0067
Mailing Address - Country:US
Mailing Address - Phone:707-465-1000
Mailing Address - Fax:
Practice Address - Street 1:1520 GASQUET FLAT
Practice Address - Street 2:
Practice Address - City:GASQUET
Practice Address - State:CA
Practice Address - Zip Code:95543-0067
Practice Address - Country:US
Practice Address - Phone:707-465-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-25
Last Update Date:2025-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 8414103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical