Provider Demographics
NPI:1710045356
Name:RUBY, DIANE LYNN (MS, LPC, CAC III)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:LYNN
Last Name:RUBY
Suffix:
Gender:F
Credentials:MS, LPC, CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 STOUT ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-2827
Mailing Address - Country:US
Mailing Address - Phone:303-312-9568
Mailing Address - Fax:303-293-6511
Practice Address - Street 1:2130 STOUT ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-2827
Practice Address - Country:US
Practice Address - Phone:303-312-9568
Practice Address - Fax:303-293-6511
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1420101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional