Provider Demographics
NPI:1326269572
Name:RUTHERFORD, MARY HOOTON (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:HOOTON
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:HOOTON
Other - Last Name:RUTHERFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW AT
Mailing Address - Street 1:3205 WHITEPINE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3205 WHITEPINE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757
Practice Address - Country:US
Practice Address - Phone:512-750-1922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX572511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181158001Medicaid
TX581884OtherVALUEOPTIONS
TX581884OtherVALUEOPTIONS