Provider Demographics
NPI:1093484230
Name:RUHTER, TEAGUE
Entity Type:Individual
Prefix:
First Name:TEAGUE
Middle Name:
Last Name:RUHTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19001 KILFINAN ST
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-1021
Mailing Address - Country:US
Mailing Address - Phone:208-731-7332
Mailing Address - Fax:
Practice Address - Street 1:223 E THOUSAND OAKS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-7708
Practice Address - Country:US
Practice Address - Phone:805-418-9952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician