Provider Demographics
NPI:1255461927
Name:KOCH RUIZ, MARY B (LPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:B
Last Name:KOCH RUIZ
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 1:1630 LIME HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-1859
Mailing Address - Country:US
Mailing Address - Phone:412-897-1827
Mailing Address - Fax:
Practice Address - Street 1:6315 FORBES AVE STE L110C
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-1745
Practice Address - Country:US
Practice Address - Phone:412-256-8753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001770101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor