Provider Demographics
NPI:1659764637
Name:RUBEN, CARISSA JEAN (MA, MFTC)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:JEAN
Last Name:RUBEN
Suffix:
Gender:F
Credentials:MA, MFTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6330 FARTHING DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-7504
Mailing Address - Country:US
Mailing Address - Phone:303-656-0813
Mailing Address - Fax:
Practice Address - Street 1:6330 FARTHING DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-7504
Practice Address - Country:US
Practice Address - Phone:303-656-0813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-14
Last Update Date:2015-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFTC0013475106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist