Provider Demographics
NPI:1114580289
Name:RUIZ, IRISEMA Y (MS, LCDC)
Entity Type:Individual
Prefix:
First Name:IRISEMA
Middle Name:Y
Last Name:RUIZ
Suffix:
Gender:F
Credentials:MS, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 18TH ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-3463
Mailing Address - Country:US
Mailing Address - Phone:361-887-7070
Mailing Address - Fax:361-887-7030
Practice Address - Street 1:1633 18TH ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-3463
Practice Address - Country:US
Practice Address - Phone:361-887-7070
Practice Address - Fax:361-887-7030
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)