Individual
THOMAS RUDERSTALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
2120 S MCCLINTOCK DR, STE. 105, TEMPE, AZ 85282-2692
(480) 804-0326
(480) 302-7884
Mailing address
1400 E SOUTHERN AVE, SUITE 735, TEMPE, AZ 85282-5691
(480) 804-0326
(480) 302-7884
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LAC-14239
AZ
101YP2500X
Professional Counselor
Primary
LPC-15817
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
069063
—
AZ
Enumeration date
07/08/2015
Last updated
07/23/2024
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