Provider Demographics
NPI:1467619932
Name:RUIZ, ANDREA MARIE (MA, LIMHP)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:MARIE
Last Name:RUIZ
Suffix:
Gender:F
Credentials:MA, LIMHP
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:MARIE
Other - Last Name:KERR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, PLMHP
Mailing Address - Street 1:2748 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-3252
Mailing Address - Country:US
Mailing Address - Phone:402-580-0124
Mailing Address - Fax:855-481-0775
Practice Address - Street 1:2748 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3252
Practice Address - Country:US
Practice Address - Phone:402-580-0124
Practice Address - Fax:855-481-0775
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1184101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health