Provider Demographics
NPI:1083986087
Name:RUFFIN, TERRILYN JO-ANNE
Entity Type:Individual
Prefix:MS
First Name:TERRILYN
Middle Name:JO-ANNE
Last Name:RUFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5038 N BAYOU BLACK DR
Mailing Address - Street 2:
Mailing Address - City:GIBSON
Mailing Address - State:LA
Mailing Address - Zip Code:70356-3114
Mailing Address - Country:US
Mailing Address - Phone:985-346-2192
Mailing Address - Fax:
Practice Address - Street 1:420 MAGNOLIA ST
Practice Address - Street 2:420 MAGNOLIA ST.
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-6304
Practice Address - Country:US
Practice Address - Phone:985-879-3966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251B00000XAgenciesCase Management