Provider Demographics
NPI:1356732978
Name:RUFF, ALISA D (PC)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:D
Last Name:RUFF
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-1474
Mailing Address - Country:US
Mailing Address - Phone:440-286-1631
Mailing Address - Fax:440-286-1634
Practice Address - Street 1:695 SOUTH ST
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-1474
Practice Address - Country:US
Practice Address - Phone:440-286-1631
Practice Address - Fax:440-286-1634
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1500147101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor