Provider Demographics
NPI:1265554257
Name:RUTH, DOUGLASS MCDONALD (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:DOUGLASS
Middle Name:MCDONALD
Last Name:RUTH
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4213 NE 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-7103
Mailing Address - Country:US
Mailing Address - Phone:503-705-3134
Mailing Address - Fax:440-756-1547
Practice Address - Street 1:1221 SW YAMHILL ST
Practice Address - Street 2:SUITE 301
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2126
Practice Address - Country:US
Practice Address - Phone:503-226-7079
Practice Address - Fax:503-226-1130
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL0045131041C0700X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORL004513OtherL.C.S.W
ORL004513OtherL.C.S.W