Provider Demographics
NPI:1336857671
Name:MOON, RUBY (EDS, NCSP, LMHCA)
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:
Last Name:MOON
Suffix:
Gender:F
Credentials:EDS, NCSP, LMHCA
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:RUTH
Other - Last Name:SQUEZELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDS, NCSP, LMHCA
Mailing Address - Street 1:522 W RIVERSIDE AVE STE N
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0580
Mailing Address - Country:US
Mailing Address - Phone:509-720-8052
Mailing Address - Fax:
Practice Address - Street 1:7 S HOWARD ST STE 216
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-3816
Practice Address - Country:US
Practice Address - Phone:509-720-8052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA499286C103TS0200X
WAMC61324957101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty