Individual
MRS. CHRISTA RUGH DETZEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.C.S.W., L.M.F.T.
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34002670A
IN
106H00000X
Marriage & Family Therapist
35001105A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000385233
ANTHEM BCBS PROVIDER PIN
IN
Enumeration date
06/02/2006
Last updated
07/18/2007
Update your record
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