Provider Demographics
NPI:1497093330
Name:RUZGYTE, EDITA (PHD)
Entity type:Individual
Prefix:
First Name:EDITA
Middle Name:
Last Name:RUZGYTE
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 1:3001 AVENUE D
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76105-1518
Mailing Address - Country:US
Mailing Address - Phone:972-658-5422
Mailing Address - Fax:
Practice Address - Street 1:604 CANDLEWOOD RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76103-1112
Practice Address - Country:US
Practice Address - Phone:972-658-5422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62048101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional