Individual
SAMUEL EMILE RUTHERFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DR.
Contact information
Practice address
1481 W 10TH ST, INDIANAPOLIS, IN 46202-2803
(317) 544-0000
Mailing address
1255 PEARL ST STE 101, EUGENE, OR 97401-3570
(541) 799-5386
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
T-16-097
OR
101YM0800X
Mental Health Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
20043782B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500676126
—
OR
05
—
500720412
—
OR
Enumeration date
08/06/2014
Last updated
08/19/2024
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