Individual
CHANCEY MARIE RUIZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCDC
Contact information
Practice address
2111 W US HIGHWAY 377, GRANBURY, TX 76048-5627
(817) 573-6002
(817) 573-6009
Mailing address
239 S VIRGINIA ST, STEPHENVILLE, TX 76401-4344
(254) 965-5515
(254) 965-7416
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
13133
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148686201
—
TX
Enumeration date
09/21/2015
Last updated
09/21/2015
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