Provider Demographics
NPI:1992243927
Name:RUTH, PAUL (ACMHC)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:RUTH
Suffix:
Gender:M
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 N MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-4014
Mailing Address - Country:US
Mailing Address - Phone:801-623-7538
Mailing Address - Fax:
Practice Address - Street 1:1220 N MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-4014
Practice Address - Country:US
Practice Address - Phone:801-623-7538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9282071-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health