Provider Demographics
NPI:1811507809
Name:RUTHERFORD, ANITA ANN
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:ANN
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14900 LASATER RD TR 236
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75253
Mailing Address - Country:US
Mailing Address - Phone:972-201-7300
Mailing Address - Fax:
Practice Address - Street 1:14900 LASATER RD TR 236
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75253
Practice Address - Country:US
Practice Address - Phone:972-201-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14783101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor