Provider Demographics
NPI:1710366802
Name:C ALLEN RUYLE LICENSED CLINICAL SOCIAL WORKER, INC.
Entity Type:Organization
Organization Name:C ALLEN RUYLE LICENSED CLINICAL SOCIAL WORKER, INC.
Other - Org Name:WELL BEING PSYCHOTHERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:C.
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:RUYLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CGP
Authorized Official - Phone:619-213-3000
Mailing Address - Street 1:333 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-6215
Mailing Address - Country:US
Mailing Address - Phone:619-213-3000
Mailing Address - Fax:866-302-7589
Practice Address - Street 1:333 OLIVE ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-6215
Practice Address - Country:US
Practice Address - Phone:619-213-3000
Practice Address - Fax:866-302-7589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGD759AMedicare PIN