Provider Demographics
NPI:1992814925
Name:RUBY, SUSAN (MA, LMHC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:RUBY
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10500 BEARDSLEE BLVD UNIT 1881
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98041-0347
Mailing Address - Country:US
Mailing Address - Phone:206-915-9876
Mailing Address - Fax:425-286-6116
Practice Address - Street 1:22602 14TH PL W
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-9438
Practice Address - Country:US
Practice Address - Phone:206-915-9876
Practice Address - Fax:425-286-6116
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00011015101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional