Provider Demographics
NPI:1215518725
Name:RUTHERFORD, WILLIE MAE (CMHT)
Entity type:Individual
Prefix:
First Name:WILLIE
Middle Name:MAE
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:CMHT
Other - Prefix:MS
Other - First Name:WILLIE
Other - Middle Name:M
Other - Last Name:RUTHERFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMHT
Mailing Address - Street 1:3087 SIMPSON HIGHWAY 13
Mailing Address - Street 2:
Mailing Address - City:MENDENHALL
Mailing Address - State:MS
Mailing Address - Zip Code:39114-3077
Mailing Address - Country:US
Mailing Address - Phone:601-847-4410
Mailing Address - Fax:601-824-0349
Practice Address - Street 1:3087 SIMPSON HIGHWAY 13
Practice Address - Street 2:
Practice Address - City:MENDENHALL
Practice Address - State:MS
Practice Address - Zip Code:39114-3077
Practice Address - Country:US
Practice Address - Phone:601-847-4410
Practice Address - Fax:601-824-0349
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health