Provider Demographics
NPI:1518128198
Name:RUTTNER - DURYEA, CANDICE APRIL (MFT)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:APRIL
Last Name:RUTTNER - DURYEA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 HIGH BLUFF DRIVE
Mailing Address - Street 2:SUITE #215
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130
Mailing Address - Country:US
Mailing Address - Phone:909-658-5816
Mailing Address - Fax:909-792-6507
Practice Address - Street 1:1265 HIGH BLUFF DR.
Practice Address - Street 2:STE 215
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130
Practice Address - Country:US
Practice Address - Phone:909-658-5816
Practice Address - Fax:909-792-6507
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45202106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist