Provider Demographics
NPI:1962763615
Name:HARTSHORN, RUBY MARIE (LPCC-S)
Entity type:Individual
Prefix:
First Name:RUBY
Middle Name:MARIE
Last Name:HARTSHORN
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:RUBY
Other - Middle Name:MARIE
Other - Last Name:WATTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3745 WHIPPLE AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-4805
Mailing Address - Country:US
Mailing Address - Phone:303-331-7506
Mailing Address - Fax:234-285-6767
Practice Address - Street 1:3745 WHIPPLE AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-4805
Practice Address - Country:US
Practice Address - Phone:303-331-7506
Practice Address - Fax:234-285-6767
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2102269-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0275720Medicaid