Thomas Ruderstaller, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC-15817 Issued in AZ

Practice address

2120 S McClintock Dr
Ste. 105
Tempe, AZ 85282-2692

Phone

(480) 804-0326

Fax

(480) 302-7884

NPI assigned

Jul 8, 2015

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lifestream Counseling LLC

  • Mental Health Counselor
  • Mesa, AZ
  • NPI 1083437297
  NPD Authorized official
• Lifestream Therapy, LLC

  • Mental Health Counselor
  • Mesa, AZ
  • NPI 1972381846
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1436313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721692800000",
    "number": "1043693096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 E SOUTHERN AVE",
            "address_2": "SUITE 735",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852825691",
            "telephone_number": "480-804-0326",
            "fax_number": "480-302-7884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2120 S MCCLINTOCK DR",
            "address_2": "STE. 105",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852822692",
            "telephone_number": "480-804-0326",
            "fax_number": "480-302-7884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDERSTALLER",
        "first_name": "THOMAS",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-08",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AZ",
            "license": "LAC-14239",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AZ",
            "license": "LPC-15817",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "069063",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Theophano Lykos Rozan, SLPA
• Spencer Ruben, DO
• Anthony Leo Rubin, MA
• Mark Leslie Rubin, M.D.
• Kiana Rose Ruch, ND
• Kristy Ann Ruidiaz, RN
• Leytocha Evette Ruinard, N.D.
• Dale Todd Ruiter, P.T.
• Guillermo Ruiz, NMD
• Olivia Ruiz

• Professional Counselor in Tempe, AZ
• Providers in Tempe, AZ by specialty
• Professional Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.