Provider Demographics
NPI:1841539517
Name:BURRIS, RUBY CHRISTINA (LMFTA)
Entity type:Individual
Prefix:
First Name:RUBY
Middle Name:CHRISTINA
Last Name:BURRIS
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 TOURMALINE DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8849
Mailing Address - Country:US
Mailing Address - Phone:317-397-3224
Mailing Address - Fax:
Practice Address - Street 1:120 CAMILLA COURT
Practice Address - Street 2:SUITE D
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074
Practice Address - Country:US
Practice Address - Phone:317-397-3224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN85000132A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist