Provider Demographics
NPI:1942849211
Name:DOUGLAS, RUTH (CG 61026440)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:CG 61026440
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5411 E MILL PLAIN BLVD STE 16
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-7046
Mailing Address - Country:US
Mailing Address - Phone:360-831-0904
Mailing Address - Fax:
Practice Address - Street 1:5411 E MILL PLAIN BLVD STE 16
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-7046
Practice Address - Country:US
Practice Address - Phone:360-831-0904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health