Provider Demographics
NPI:1750054243
Name:RUTA, SHAWN FORREST
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:FORREST
Last Name:RUTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:857 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-2721
Mailing Address - Country:US
Mailing Address - Phone:530-737-8916
Mailing Address - Fax:
Practice Address - Street 1:857 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-2721
Practice Address - Country:US
Practice Address - Phone:530-737-8916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CAAMFT139291106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist