Provider Demographics
NPI:1336139583
Name:RUHROLD, RICHARD E (PHD, HSPP)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
Last Name:RUHROLD
Suffix:
Gender:M
Credentials:PHD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-3880
Mailing Address - Country:US
Mailing Address - Phone:574-267-7169
Mailing Address - Fax:574-269-4185
Practice Address - Street 1:850 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3163
Practice Address - Country:US
Practice Address - Phone:574-267-7169
Practice Address - Fax:574-269-3995
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040225A103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200040230AMedicaid
IN200040223AMedicaid
INM400033615Medicare PIN
IN452280BMedicare ID - Type UnspecifiedPROVIDER ID