Provider Demographics
NPI:1730202474
Name:OMLIN, RUTH (MPS, LPAT)
Entity type:Individual
Prefix:MS
First Name:RUTH
Middle Name:
Last Name:OMLIN
Suffix:
Gender:F
Credentials:MPS, LPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 CALLE CABALLERO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-5002
Mailing Address - Country:US
Mailing Address - Phone:505-473-1843
Mailing Address - Fax:
Practice Address - Street 1:3008 CALLE CABALLERO
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-5002
Practice Address - Country:US
Practice Address - Phone:505-473-1843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM005693101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health