Provider Demographics
NPI:1437580719
Name:RUIZ, LENNY JAMES (MA CAC II)
Entity Type:Individual
Prefix:
First Name:LENNY
Middle Name:JAMES
Last Name:RUIZ
Suffix:
Gender:M
Credentials:MA CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W 8TH ST STE 403
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3033
Mailing Address - Country:US
Mailing Address - Phone:719-582-5576
Mailing Address - Fax:
Practice Address - Street 1:201 W 8TH ST STE 403
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3033
Practice Address - Country:US
Practice Address - Phone:719-582-5576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health