Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 763 | LA |
NPI | 1104061639 |
---|---|
Provider Name | Mr. Arthur Merriam Ruggles |
First Address | Shreveport, LA 71135-2153 |
Second Address | Shreveport, LA 71104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2008 |
Last Update Date | 12/12/2008 |