Provider Demographics
NPI:1770203416
Name:PRADO, RUBEN ANTONIO (MS, LLMFT)
Entity type:Individual
Prefix:
First Name:RUBEN
Middle Name:ANTONIO
Last Name:PRADO
Suffix:
Gender:M
Credentials:MS, LLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 WASHTENAW RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-2126
Mailing Address - Country:US
Mailing Address - Phone:315-771-4657
Mailing Address - Fax:
Practice Address - Street 1:2350 GREEN RD STE 160
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-1572
Practice Address - Country:US
Practice Address - Phone:315-771-4657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4151001066106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist