Provider Demographics
NPI:1073970596
Name:RACZ, RUTH PERRY (LPC)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:PERRY
Last Name:RACZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19815 BAY BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-9234
Mailing Address - Country:US
Mailing Address - Phone:334-222-2523
Mailing Address - Fax:334-222-4660
Practice Address - Street 1:19815 BAY BRANCH RD
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-9234
Practice Address - Country:US
Practice Address - Phone:334-222-2523
Practice Address - Fax:334-222-4660
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3498101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health