Individual
STACEY LYN RUBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
101 S WASHINGTON ST, MARION, IN 46952-3867
(765) 662-9971
(765) 651-6556
Mailing address
101 S WASHINGTON ST, MARION, IN 46952-3867
(765) 662-9971
(765) 651-6556
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39001719A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100124250
—
IN
Enumeration date
10/05/2005
Last updated
09/29/2015
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