Provider Demographics
NPI:1629293006
Name:RILEY, RUBY A (LPC)
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:A
Last Name:RILEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 W ADA AVE
Mailing Address - Street 2:
Mailing Address - City:WILBURTON
Mailing Address - State:OK
Mailing Address - Zip Code:74578-2416
Mailing Address - Country:US
Mailing Address - Phone:918-470-1711
Mailing Address - Fax:
Practice Address - Street 1:113 W ADA AVE
Practice Address - Street 2:
Practice Address - City:WILBURTON
Practice Address - State:OK
Practice Address - Zip Code:74578-2416
Practice Address - Country:US
Practice Address - Phone:918-470-1711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health