Provider Demographics
NPI:1043904709
Name:RUIZ-HUERTA, EDWIN ALBERTO (LPCC)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:ALBERTO
Last Name:RUIZ-HUERTA
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5439 STETSON MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-3638
Mailing Address - Country:US
Mailing Address - Phone:719-205-0163
Mailing Address - Fax:
Practice Address - Street 1:4180 CENTER PARK DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80916-4505
Practice Address - Country:US
Practice Address - Phone:719-205-0163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0020668101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health