Lawrence G. Ruffin

Primary specialty

PsychologistTaxonomy code 103T00000X

License

20041315A Issued in IN

Legal business name

LAWRENCE G. RUFFIN

Doing business as

Selah Academy, Incorporated

Practice address

1991 W 39TH CT FL 2
Gary, IN 46408-2474

Phone

(219) 980-7919

NPI assigned

Dec 28, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Aquanatte M Ruffin, MSW, LCSW

Title

Program Director

Phone

(219) 980-7919

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Selah Academy, Incorporated Doing business as

Locations

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218499200000",
    "number": "1164588745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15090",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464095090",
            "telephone_number": "219-980-7919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1991 W 39TH CT FL 2",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464082474",
            "telephone_number": "219-980-7919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAWRENCE G. RUFFIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-28",
        "last_updated": "2008-08-12",
        "status": "A",
        "authorized_official_last_name": "RUFFIN",
        "authorized_official_first_name": "AQUANATTE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "219-980-7919",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MSW, LCSW"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "IN",
            "license": "20041315A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200818150",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Selah Academy, Incorporated",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.