Provider Demographics
NPI:1275701054
Name:RUTH P. MANVILLE, LCSW, PC
Entity Type:Organization
Organization Name:RUTH P. MANVILLE, LCSW, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:MANVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:801-328-8444
Mailing Address - Street 1:370 E SOUTH TEMPLE
Mailing Address - Street 2:SUITE #240
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-1206
Mailing Address - Country:US
Mailing Address - Phone:801-328-8444
Mailing Address - Fax:801-328-4590
Practice Address - Street 1:370 E SOUTH TEMPLE
Practice Address - Street 2:SUITE #240
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-1206
Practice Address - Country:US
Practice Address - Phone:801-328-8444
Practice Address - Fax:801-328-4590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT131196-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty