Provider Demographics
NPI:1649895731
Name:RUHGE, RANDY LYLE (PLMHP, PMSW)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:LYLE
Last Name:RUHGE
Suffix:
Gender:M
Credentials:PLMHP, PMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8790 F ST STE 527
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-1538
Mailing Address - Country:US
Mailing Address - Phone:402-660-1987
Mailing Address - Fax:
Practice Address - Street 1:8790 F ST STE 527
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-1538
Practice Address - Country:US
Practice Address - Phone:402-660-1987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-15
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12221101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026865300Medicaid