Provider Demographics
NPI:1457316291
Name:WEBER, RUTH ANN (LPC, CASAC)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ANN
Last Name:WEBER
Suffix:
Gender:F
Credentials:LPC, CASAC
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:ANN
Other - Last Name:GRIFFITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4318
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583-4318
Mailing Address - Country:US
Mailing Address - Phone:573-330-5822
Mailing Address - Fax:
Practice Address - Street 1:214 CAMDEN ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MO
Practice Address - Zip Code:65555
Practice Address - Country:US
Practice Address - Phone:573-330-5822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002165101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO498594654Medicaid