Provider Demographics
NPI:1407626385
Name:RUBY WAVES OF WELLNESS, PLLC
Entity Type:Organization
Organization Name:RUBY WAVES OF WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOSIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:765-761-3997
Mailing Address - Street 1:PO BOX 374
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:IL
Mailing Address - Zip Code:61859-0374
Mailing Address - Country:US
Mailing Address - Phone:765-761-3997
Mailing Address - Fax:217-670-6712
Practice Address - Street 1:105 W PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:IL
Practice Address - Zip Code:61859-8808
Practice Address - Country:US
Practice Address - Phone:765-761-3997
Practice Address - Fax:217-670-6712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-03
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1740650530OtherNPI 1