Provider Demographics
NPI:1295818763
Name:RUBEN, DOUGLAS HOWARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:HOWARD
Last Name:RUBEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 OKEMOS RD STE 22
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3287
Mailing Address - Country:US
Mailing Address - Phone:517-347-0944
Mailing Address - Fax:517-347-0944
Practice Address - Street 1:4211 OKEMOS RD STE 22
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3287
Practice Address - Country:US
Practice Address - Phone:517-347-0944
Practice Address - Fax:517-347-0944
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI005858103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M08300Medicare ID - Type Unspecified