Provider Demographics
NPI:1083991996
Name:C. ALLEN RUYLE, LCSW
Entity Type:Organization
Organization Name:C. ALLEN RUYLE, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:C. ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUYLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CGP
Authorized Official - Phone:619-213-3000
Mailing Address - Street 1:1090 UNIVERSITY AVE
Mailing Address - Street 2:LOFT 202B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-7307
Mailing Address - Country:US
Mailing Address - Phone:619-822-1660
Mailing Address - Fax:866-302-7589
Practice Address - Street 1:1090 UNIVERSITY AVE
Practice Address - Street 2:LOFT 202B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-7307
Practice Address - Country:US
Practice Address - Phone:619-822-1660
Practice Address - Fax:866-302-7589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-05
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS268091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty