Provider Demographics
NPI:1679844328
Name:RUDING, TINA MARIE (BA, BHRS)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:RUDING
Suffix:
Gender:F
Credentials:BA, BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 W. GARRIOTT
Mailing Address - Street 2:SUITE F
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703
Mailing Address - Country:US
Mailing Address - Phone:580-242-4673
Mailing Address - Fax:580-242-4679
Practice Address - Street 1:1625 W GARRIOTT RD
Practice Address - Street 2:SUITE F
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-5653
Practice Address - Country:US
Practice Address - Phone:580-242-4673
Practice Address - Fax:580-242-4679
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst