Provider Demographics
NPI:1700196136
Name:RUTHERFORD, BILLY JACK (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BILLY
Middle Name:JACK
Last Name:RUTHERFORD
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1540 SPRING VALLEY DR
Mailing Address - Street 2:HUNTINGTON VA MEDICAL CENTER
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704-9300
Mailing Address - Country:US
Mailing Address - Phone:304-429-6755
Mailing Address - Fax:304-429-7562
Practice Address - Street 1:1540 SPRING VALLEY DR
Practice Address - Street 2:HUNTINGTON VA MEDICAL CENTER
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704-9300
Practice Address - Country:US
Practice Address - Phone:304-429-6755
Practice Address - Fax:304-429-7562
Is Sole Proprietor?:No
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1007103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical