Provider Demographics
NPI:1699852574
Name:RUYLE AND ASSOCIATES
Entity Type:Organization
Organization Name:RUYLE AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:RUYLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:231-737-4444
Mailing Address - Street 1:3535 PARK ST
Mailing Address - Street 2:SUITE 101B
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-3736
Mailing Address - Country:US
Mailing Address - Phone:231-737-4444
Mailing Address - Fax:231-737-5555
Practice Address - Street 1:3535 PARK ST
Practice Address - Street 2:SUITE 101B
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-3736
Practice Address - Country:US
Practice Address - Phone:231-737-4444
Practice Address - Fax:231-737-5555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI104100000X, 106H00000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherSALES TAX NUMBER
MI0P11980Medicare PIN
MIOP11980002Medicare ID - Type UnspecifiedMEDICARE NUMBER