Provider Demographics
NPI:1811560238
Name:RUD COUNSELING & PSYCHOTHERAPY PLLC
Entity Type:Organization
Organization Name:RUD COUNSELING & PSYCHOTHERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EARTHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAMON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC-S
Authorized Official - Phone:817-466-4450
Mailing Address - Street 1:910 S CROWLEY RD STE 9-348
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-3686
Mailing Address - Country:US
Mailing Address - Phone:817-466-4450
Mailing Address - Fax:817-423-7706
Practice Address - Street 1:1459 CONLEY LN
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-1270
Practice Address - Country:US
Practice Address - Phone:817-466-4450
Practice Address - Fax:817-423-7706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0279341-01Medicaid