Provider Demographics
NPI:1669727947
Name:AUTEN, RUTH ANN (LMFT)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ANN
Last Name:AUTEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32538
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95152-2538
Mailing Address - Country:US
Mailing Address - Phone:408-876-0909
Mailing Address - Fax:
Practice Address - Street 1:877 W FREMONT AVE
Practice Address - Street 2:SUITE K-6
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-2315
Practice Address - Country:US
Practice Address - Phone:408-876-0909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49702106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFT 043 00 NOtherBLUE SHIELD OF CALIFORNIA