Provider Demographics
NPI:1144776956
Name:MENTAL HEALTH WITH DR RUTH
Entity Type:Organization
Organization Name:MENTAL HEALTH WITH DR RUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:R
Authorized Official - Last Name:WHITELY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:903-355-4571
Mailing Address - Street 1:5604 WESLEY ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-6326
Mailing Address - Country:US
Mailing Address - Phone:903-274-4140
Mailing Address - Fax:877-310-9115
Practice Address - Street 1:5604 WESLEY ST
Practice Address - Street 2:SUITE 103
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-6326
Practice Address - Country:US
Practice Address - Phone:903-274-4140
Practice Address - Fax:877-310-9115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62293101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2808701-01Medicaid