Provider Demographics
NPI:1265544126
Name:L E RUCKSTUHL INC
Entity type:Organization
Organization Name:L E RUCKSTUHL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LIONEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:RUCKSTUHL
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:775-787-7028
Mailing Address - Street 1:5421 KIETZKE LANE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-1088
Mailing Address - Country:US
Mailing Address - Phone:775-787-7028
Mailing Address - Fax:877-738-0730
Practice Address - Street 1:5421 KIETZKE LN
Practice Address - Street 2:SUITE 202
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-1088
Practice Address - Country:US
Practice Address - Phone:775-787-7028
Practice Address - Fax:877-738-0730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0462103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100502901Medicaid