Provider Demographics
NPI:1447429527
Name:MANN, RUTH L (MA)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:L
Last Name:MANN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 W PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4607
Mailing Address - Country:US
Mailing Address - Phone:602-548-8508
Mailing Address - Fax:602-841-0236
Practice Address - Street 1:3420 W PEORIA AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4607
Practice Address - Country:US
Practice Address - Phone:602-548-8508
Practice Address - Fax:602-841-0236
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-12409101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional