Provider Demographics
NPI:1730375619
Name:RUGE, NATALIE O (LMFT)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:O
Last Name:RUGE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7545 CENTURION PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4118
Mailing Address - Country:US
Mailing Address - Phone:904-651-5102
Mailing Address - Fax:773-897-1726
Practice Address - Street 1:7545 CENTURION PKWY STE 104
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-4118
Practice Address - Country:US
Practice Address - Phone:904-651-5102
Practice Address - Fax:773-897-1726
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2419106H00000X
CAIMF 51455106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist