Provider Demographics
NPI:1598396483
Name:RUIZ, AMBER CELESTE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:CELESTE
Last Name:RUIZ
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:CELESTE
Other - Last Name:CHAVEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:902 BONHAM ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-5566
Mailing Address - Country:US
Mailing Address - Phone:432-770-6369
Mailing Address - Fax:
Practice Address - Street 1:2301 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5829
Practice Address - Country:US
Practice Address - Phone:432-620-1160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14128101YA0400X
TX58613104100000X
TX78192101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker