Provider Demographics
NPI:1992213607
Name:RUZ, SHERYLL
Entity Type:Individual
Prefix:
First Name:SHERYLL
Middle Name:
Last Name:RUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 E OLD TRENTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5945
Mailing Address - Country:US
Mailing Address - Phone:931-444-1449
Mailing Address - Fax:
Practice Address - Street 1:139 E OLD TRENTON RD STE B
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5945
Practice Address - Country:US
Practice Address - Phone:931-444-1449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-16
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLBA0000000707103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty