Provider Demographics
NPI:1982639167
Name:BURTON-PUGH, RUTH ANN (LPC)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:ANN
Last Name:BURTON-PUGH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 NW 111 STREET
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114
Mailing Address - Country:US
Mailing Address - Phone:405-640-1516
Mailing Address - Fax:405-749-1844
Practice Address - Street 1:1330 N CLASSEN
Practice Address - Street 2:STE 314
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-6834
Practice Address - Country:US
Practice Address - Phone:405-601-2307
Practice Address - Fax:405-601-3317
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLPC 3551101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200077440AMedicaid