Provider Demographics
NPI:1053565523
Name:RUCH, GREGORY LYNN (MS)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:LYNN
Last Name:RUCH
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9046 DRIFTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-2095
Mailing Address - Country:US
Mailing Address - Phone:405-401-3778
Mailing Address - Fax:
Practice Address - Street 1:9046 DRIFTWOOD CT
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-2095
Practice Address - Country:US
Practice Address - Phone:405-401-3778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS291101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional