Provider Demographics
NPI:1750316428
Name:OSWOOD, RUTH MARY (LPCC)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:MARY
Last Name:OSWOOD
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 RAYS COR # A
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-8502
Mailing Address - Country:US
Mailing Address - Phone:505-753-0773
Mailing Address - Fax:505-753-0775
Practice Address - Street 1:1100 N PASEO DE ONATE
Practice Address - Street 2:A
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-3454
Practice Address - Country:US
Practice Address - Phone:505-753-0773
Practice Address - Fax:505-753-0775
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0061212101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM61058076Medicaid