1265554257 NPI number — MR. DOUGLASS MCDONALD RUTH M.S.W., L.C.S.W.

Table of content: RICHARD COLLIER NEAL (NPI 1619955655)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265554257 NPI number — MR. DOUGLASS MCDONALD RUTH M.S.W., L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUTH
Provider First Name:
DOUGLASS
Provider Middle Name:
MCDONALD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.S.W., L.C.S.W.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265554257
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4213 NE 28TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97211-7103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-705-3134
Provider Business Mailing Address Fax Number:
440-756-1547

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1221 SW YAMHILL ST
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97205-2126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-226-7079
Provider Business Practice Location Address Fax Number:
503-226-1130
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  L004513 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: L004513 . This is a "L.C.S.W" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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