Basic Information
| Provider Information | |||||||||
| NPI: | 1659496768 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUH | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | L.P.C.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 8970 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436230970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194754449 | ||||||||
| FaxNumber: | 4195171399 | ||||||||
| Practice Location | |||||||||
| Address1: | 2109 HUGHES DR | ||||||||
| Address2: | JOBST TOWER #640 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436063856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196610505 | ||||||||
| FaxNumber: | 4192916436 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 08/14/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | E0002780 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 188839-000 | 01 | MAGELLAN HEALTH SERVICE | OTHER |