Provider Demographics
NPI:1912159393
Name:RUDDELL, RICHARD LEE JR (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LEE
Last Name:RUDDELL
Suffix:JR
Gender:M
Credentials:MA, LPC
Other - Prefix:
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Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-0015
Mailing Address - Country:US
Mailing Address - Phone:541-997-6261
Mailing Address - Fax:541-997-8606
Practice Address - Street 1:1445 8TH ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439-9351
Practice Address - Country:US
Practice Address - Phone:541-997-6261
Practice Address - Fax:541-997-8606
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORC3061101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional