Provider Demographics
NPI:1275646960
Name:RUFF, CHARLIE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:CHARLIE
Middle Name:
Last Name:RUFF
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7549 CREEKRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-3244
Mailing Address - Country:US
Mailing Address - Phone:925-323-5182
Mailing Address - Fax:916-910-9412
Practice Address - Street 1:6381 AUBURN BLVD
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95621-5273
Practice Address - Country:US
Practice Address - Phone:916-910-9412
Practice Address - Fax:916-910-9412
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 38646106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
600770897OtherMAGELLAN
CA694942OtherVALUE OPTIONS
CA01674894OtherALAMEDA COUNTY BEHAVIORAL
CA08082OtherCONTRA COSTA COUNTY MENTA
CAMFT386460OtherBLUE SHIELD
CA272686OtherMHN