Provider Demographics
NPI:1043904709
Name:RUIZ, EDWIN (LPCC)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:RUIZ
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 N ACADEMY BLVD STE 264
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1568
Mailing Address - Country:US
Mailing Address - Phone:719-399-3981
Mailing Address - Fax:
Practice Address - Street 1:2020 N ACADEMY BLVD STE 264
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1568
Practice Address - Country:US
Practice Address - Phone:719-399-3981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0020668101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health