Provider Demographics
NPI:1356815948
Name:RUBLE, WILLIAM BLAKELY (NCC, LPC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:BLAKELY
Last Name:RUBLE
Suffix:
Gender:M
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13701 W JEWELL AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-4173
Mailing Address - Country:US
Mailing Address - Phone:901-581-6563
Mailing Address - Fax:
Practice Address - Street 1:13701 W JEWELL AVE STE 270
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-4173
Practice Address - Country:US
Practice Address - Phone:901-581-6563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-16
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0015527101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty