Provider Demographics
NPI:1376915637
Name:RUIZ, VICKI J (LPCC)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:J
Last Name:RUIZ
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 BROADWAY BLVD SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3425
Mailing Address - Country:US
Mailing Address - Phone:505-242-6988
Mailing Address - Fax:505-242-6972
Practice Address - Street 1:218 BROADWAY BLVD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3425
Practice Address - Country:US
Practice Address - Phone:505-242-6988
Practice Address - Fax:505-242-6972
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0161561101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health