Provider Demographics
NPI:1598891384
Name:MCINNES, RUTH ANN (MA LCPC)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ANN
Last Name:MCINNES
Suffix:
Gender:F
Credentials:MA LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MOONEY DR
Mailing Address - Street 2:STE#1
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-2171
Mailing Address - Country:US
Mailing Address - Phone:815-933-7887
Mailing Address - Fax:815-933-7870
Practice Address - Street 1:110 MOONEY DR
Practice Address - Street 2:STE#1
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2171
Practice Address - Country:US
Practice Address - Phone:815-933-7887
Practice Address - Fax:815-933-7870
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional