Provider Demographics
NPI:1447676770
Name:JOHNS, RUBY
Entity type:Individual
Prefix:
First Name:RUBY
Middle Name:
Last Name:JOHNS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 N 24TH
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401
Mailing Address - Country:US
Mailing Address - Phone:918-485-3554
Mailing Address - Fax:918-485-8371
Practice Address - Street 1:403 N 24TH
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401
Practice Address - Country:US
Practice Address - Phone:918-485-3554
Practice Address - Fax:918-485-8371
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)