Provider Demographics
NPI:1023296902
Name:RUTH, JENNIFER WAHL (LMHC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WAHL
Last Name:RUTH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10069 N FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-7447
Mailing Address - Country:US
Mailing Address - Phone:813-464-4025
Mailing Address - Fax:813-464-4025
Practice Address - Street 1:10069 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7447
Practice Address - Country:US
Practice Address - Phone:813-464-4025
Practice Address - Fax:813-464-4025
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH49271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical