| Mariah Ruffin | |
|
1405 Eliza St Fort Wayne IN 46803-2035 | |
| (260) 431-1213 | |
| Not Available |
| Full Name | Mariah Ruffin |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1405 Eliza St, Fort Wayne, Indiana |
| Authorized Official Name and Position | Mariah Ruffin (OWNER) |
| Authorized Official Contact | 2604311213 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mariah Ruffin 1405 Eliza St Fort Wayne IN 46803-2035 Ph: (260) 431-1213 | Mariah Ruffin 1405 Eliza St Fort Wayne IN 46803-2035 Ph: (260) 431-1213 |
| NPI Number | 1457814139 |
|---|---|
| Provider Enumeration Date | 04/10/2019 |
| Last Update Date | 04/10/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457814139 | NPI | - | NPPES |
| 300022892 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 385H00000X | Respite Care | (* (Not Available)) | Secondary |
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