Ruby Taylor Koontz | Valparaiso, IN • PECOS Search

Ruby Taylor Koontz

Counselor

Behavioral Health & Social Service Providers

2005 Valparaiso St Ste 209, Valparaiso, IN 46383-3331

(219) 252-5464 (219) 242-0210

PECOS Enrollment

Based on the most recent information from CMS, provider Ruby Taylor Koontz does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 4 days ago.

Profile Details

Provider ID
1306573050
Provider Type
Individual
Full Name
Koontz, Ruby Taylor
Gender
Female

Sole Proprietor
No
Enumeration Date
8/3/2022
Last Updated
8/3/2022

Contact Information

Practice Location

2005 Valparaiso St Ste 209, Valparaiso, IN 46383-3331

Unlisted Fax

Mailing Location

1625 Oriole Dr, Munster, IN 46321-3336

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 101YM0800X Primary	Description Counselor Behavioral Health & Social Service Providers	License Unlisted Issuer