Provider Demographics
NPI:1659910701
Name:RUTLEDGE, LAURA E (LPC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:RUTLEDGE
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 1:1437 OLD SQUARE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-5533
Mailing Address - Country:US
Mailing Address - Phone:601-977-9353
Mailing Address - Fax:601-977-9422
Practice Address - Street 1:1437 OLD SQUARE RD STE 101
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-5533
Practice Address - Country:US
Practice Address - Phone:601-977-9353
Practice Address - Fax:601-977-9422
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2550101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health