Provider Demographics
NPI:1487959144
Name:ELAIJE, RUTH H (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:H
Last Name:ELAIJE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:H
Other - Last Name:KEAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:2922 PECAN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-4631
Mailing Address - Country:US
Mailing Address - Phone:512-841-5894
Mailing Address - Fax:
Practice Address - Street 1:2922 PECAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-4631
Practice Address - Country:US
Practice Address - Phone:512-841-5894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63415101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health