Provider Demographics
NPI:1780264101
Name:RUCKER, BENJAMIN ALAN (LMHC)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ALAN
Last Name:RUCKER
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2624 N DIVISION ST # 1009
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-2129
Mailing Address - Country:US
Mailing Address - Phone:612-799-5707
Mailing Address - Fax:971-369-9478
Practice Address - Street 1:2624 N DIVISION ST # 1009
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-2129
Practice Address - Country:US
Practice Address - Phone:612-799-5707
Practice Address - Fax:971-369-9478
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61531529101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty