Provider Demographics
NPI:1730950767
Name:WEINZETTLE, RUTH T (PH D, LCSW)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:T
Last Name:WEINZETTLE
Suffix:
Gender:F
Credentials:PH D, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 WHITE ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-6362
Mailing Address - Country:US
Mailing Address - Phone:318-623-5613
Mailing Address - Fax:
Practice Address - Street 1:2036 JACKSON ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-6439
Practice Address - Country:US
Practice Address - Phone:318-641-0444
Practice Address - Fax:318-641-6118
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2242101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health