Provider Demographics
NPI:1851018303
Name:RUBY, EMILY ELISE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ELISE
Last Name:RUBY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3374 WEMPLE RD
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-8160
Mailing Address - Country:US
Mailing Address - Phone:734-788-5362
Mailing Address - Fax:
Practice Address - Street 1:3374 WEMPLE RD
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-8160
Practice Address - Country:US
Practice Address - Phone:734-788-5362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401018961101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor