Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | 004405 | GA |
Y | 103TC1900X | Counseling Psychologist | 1323 | SC |
NPI | 1063483741 |
---|---|
Provider Name | Christopher Ruth |
First Address | Clemson, SC 29631-2347 |
Second Address | Clemson, SC 29631-2241 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 04/07/2017 |