Provider Demographics
NPI:1770787202
Name:RUFFIN, GEORGE L (PHD LPC LMFT LCDC)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:L
Last Name:RUFFIN
Suffix:
Gender:M
Credentials:PHD LPC LMFT LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5436 RANDOL DR
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-6822
Mailing Address - Country:US
Mailing Address - Phone:817-657-9326
Mailing Address - Fax:817-281-0795
Practice Address - Street 1:6900 BOULEVARD 26
Practice Address - Street 2:
Practice Address - City:RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76118
Practice Address - Country:US
Practice Address - Phone:817-429-4769
Practice Address - Fax:817-457-7906
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2741101YA0400X
TX7513103TP0814X
TX2332106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029025601Medicaid