Provider Demographics
NPI:1447264833
Name:KAUFFOLD, RUTH E (PHD)
Entity type:Individual
Prefix:DR
First Name:RUTH
Middle Name:E
Last Name:KAUFFOLD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 SOUTH MAIN ST
Mailing Address - Street 2:AGAPE COUNSELING CENTER
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458
Mailing Address - Country:US
Mailing Address - Phone:937-434-0540
Mailing Address - Fax:937-434-6726
Practice Address - Street 1:175 SOUTH MAIN ST
Practice Address - Street 2:AGAPE COUNSELING CENTER
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458
Practice Address - Country:US
Practice Address - Phone:937-434-0540
Practice Address - Fax:937-434-6726
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5643103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCP28981Medicare PIN